OBJECTIVES:  Renal impairment (RI) is a common complication of multiple myeloma (MM). Up to 61% of MM patients experience RI. This study estimated economic burden associated with RI in MM patients in the US. METHODS:  In this retrospective cohort study patients ≥ 18 years old with ≥1 inpatient or ≥2 outpatient MM diagnoses between 1/1/2008 - 3/31/2015 were identified from MarketScan® Commercial and Medicare Supplemental Databases. RI patients had ≥1 diagnosis of chronic kidney disease (CKD) Stage I-V (first CKD diagnosis date = index date) on or after the first MM diagnosis, and were propensity score matched 1:1 to MM patients without RI (controls). All patients had ≥6-month continuous enrollment prior to index date and were followed for ≥1 month from index date until the earliest of inpatient death, end of continuous enrollment, or end of the study period (9/30/2015). The average per-patient per-year (PPPY) healthcare resource utilization and costs were measured during follow-up. Costs were total reimbursed amount in 2016 dollars. RESULTS:  A total of 2,541 MM patients with CKD and 2,541 matched controls met the study criteria (mean age: 69.3-69.6 years; male: 55%; mean days in follow up: 533-572). They were well-balanced on baseline demographic, clinical characteristics and costs. Compared to controls, CKD patients had significantly higher proportions (57.1% vs. 32.1%) and number (1.2 vs. 0.5) of inpatient admissions, emergency room visits (5.1 vs. 3.3), and total costs ($106,634 vs. $71,880). Sensitivity analyses found that patients with CKD stage III-V had $38,412 higher costs and patients with CKD or end stage renal disease had $78,455 higher costs (PPPY) than matched controls. P<0.001 in all comparisons. CONCLUSIONS:  The economic burden associated with RI in patients with MM was estimated to be between $34,754 and $78,455 PPPY. Given its substantial impact, preservation of renal function is important in MM patient care.