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Abstract Background Reduced estimated glomerular filtration rate (eGFR) has been associated with increased risk of infections and infection-related hospital admissions (IRHs). It is unknown whether and to what extent patients with reduced renal function admitted to hospital with infections are predisposed to poorer outcomes and higher medical costs than people with normal renal function. In the context of China's single-disease reimbursement-payment policy, the reimbursement to the hospital is the same if patients are admitted for the same cause, regardless of comorbidities. Methods In this cross-sectional analysis, we included adults from four hospitals in Guangzhou, China, between 2012 and 2015, who had not on renal-replacement therapy and who had a discharge diagnosis of infection (identified by established ICD-10 algorithms) and an eGFR 1–12 months before index hospital admission. We compared in-hospital outcomes (death, intensive-care unit [ICU] admission, length of hospital stay [LOHS]) and medical expenses between patients with and without chronic kidney disease, defined as estimated Glomerular Filtration Rate (eGFR) of 60 mL/min per 1·73 m2 or less by mixed-effect logistic regression model or generalised linear model. Findings Among 321 571 hospital admissions, 58 166 were IRHs. 6283 (10·8%) IRHs had eGFR measured at outpatient visit. After adjusting for age, sex, and Charlson comorbidity index (excluding renal disease score), the odds ratios for in-hospital mortality (1·41; 95% CI 1·02–1·96) and ICU admission (2·18; 1·64–2·91) were highest among patients with chronic kidney disease. The median LOHS was longer for patients with chronic kidney disease than for patients without disease (11 days [IQR 8–15] days vs 10 days [7–14]; p Interpretation Patients with chronic kidney disease who were admitted to hospital with infections are at high risk of poor in-hospital outcomes, conveying higher medical costs. These findings suggest that comorbidities such as chronic kidney disease should be considered in the China Single Disease Reimbursement-Payment Policy. Increased awareness of kidney dysfunction might be required for more effective prevention of adverse modifiable outcomes due to infections. Funding This work was supported by a research grant from a project between the Guangdong Provincial Hospital of Chinese Medicine, China and the Department of Public Health Sciences, Karolinska Institutet, Sweden, and funding from Foreign Experts Project, Foreign Experts Bureau of Guangdong Province, China (GDT20164400034). GBS has a China Government scholarship from China scholarship council (201508440214). JJC acknowledges funding from Stockholm County Council, Westman and Martin Rind Foundations and the Swedish Heart and Lung Association. Baxter Novum is the result of a grant from Baxter Healthcare Corporation to Karolinska Institutet. The funding sources were not involved in data analysis, interpretation of the data, preparation, review, or approval of the manuscript. The contents are solely the responsibility of the authors and do not necessarily represent the official view of Foreign Experts Project, Foreign Experts Bureau of Guangdong Province, China.