Background Kidney disease is associated with increased complications in total joint arthroplasty (TJA). The purpose of this study was to determine the association of kidney disease severity as measured by the chronic kidney disease (CKD) staging system with complications after TJA. Methods A retrospective review of 12,308 primary TJAs (6,361 hips, 5,947 knees) from 2008-2013 was performed. The following preoperative variables were obtained from medical records: chemistry 7 panel, Elixhauser comorbidities, and demographic factors. CKD stages were defined based on estimated glomerular filtration rate (eGFR) in ml/min/1.73m2 : (1) 90+, (2) 60-89, (3A) 45-59, (3B) 30-44, (4) 15-29, and (5) <15. Multivariate analysis was performed to assess the independent influence of CKD stage on the aforementioned endpoints. Results Patients with CKD stage greater than 2 demonstrated an increased odds of receiving transfusions (p=0.001), length of stay >3 days (p=0.010), acute kidney injury (p<0.001), septic revisions (p=0.002) and in-hospital complications (p<0.001) compared to all patients with eGFR > 60 when controlling for potential confounders. Only CKD stage 3A was significantly associated with septic revisions (90 days, p=0.004; 2 years p=0.002). Additionally, the relationship between eGFR and the above complications increased linearly rather than demonstrating a clear threshold at which the risk increased substantially. Discussion Severe CKD is associated with increased transfusion, length of stay, and in-hospital complications; and complications increased linearly with disease severity. Surgeons should be cognizant of this increase when evaluating TJA patients with renal disease.