Objective: To determine the influence of renal impairment (RI) on clinical outcomes at 3 months and the risk of recurrent stroke in patients presenting with emergent large vessel occlusion (ELVO) treated with emergent endovascular treatment (EVT). Methods: Consecutive patients with anterior-circulation stroke due to ELVO treated with EVT in 21 endovascular centers were included. Multivariate regressions were used to evaluate the association of RI with mortality, functional independence [modified Rankin Scale (mRS) score of 0-2], and functional improvement (shift in mRS score) at 3 months. The association between RI and the risk of recurrent stroke was evaluated using multivariate competing-risk regression analyses. Results: Finally, 628 ELVO patients [(mean age, 64.7 ± 12.5 years, median NIHSS score, 17 points, 99 (15.8%) with RI] who underwent EVT were enrolled. After adjusting for other relevant variables, multivariate regression analysis indicated that RI was independently associated with functional independence [adjusted odds ratio (OR) 0.53, 95% confidence interval (CI), 0.29-0.96; P=0.035)] at 3 months, but not with mortality or functional improvement. Multivariate competing-risk regression analysis showed that patients with RI who received EVT had a significantly higher risk of recurrent stroke [adjusted hazard ratios (HRs) 2.56, 95% CI 1.27-5.18; P=0.009] compared to those with normal renal function. Conclusion: Our results suggest that RI is an independent predictor of functional independence at 3 months as well as long-term risk of recurrent stroke in ELVO patients treated with EVT.