Besa Pejë and Vllaznia Pozheran were relegated after finishing the previous season in eleventh and twelfth-place respectively.
They will be replaced by the champions and runners-up of the 2017–18 First League, Ballkani and KEK respectively.
Ferizaj defeated Vëllaznimi in play-off to claim their top-flight spot.
The ninth and tenth-placed teams, Trepça'89 and Gjilani respectively, each paired off against the third and fourth-placed teams from the 2018–19 First Football League of Kosovo season, Vëllaznimi and Besa Pejë respectively; the two winners will play in the top-flight next season.
As with previous seasons, both play-offs will be played on neutral ground.