We examined the relationship between alcohol consumption and incidence of end-stage renal disease (ESRD) in a prospective cohort of 65 601 Chinese men aged 40 years and older. Information on the amount and type of alcohol consumed was collected at a baseline examination with follow-up evaluations conducted 8-9 years later. During the 500 876 person-years of follow-up, 176 participants initiated renal replacement therapy or died from renal failure. Compared to non-drinkers, the relative risk of ESRD was 0.67 among men consuming less than 21 drinks per week and 0.52 among men consuming this amount or more after adjustment for age, geographic region, urbanization, education, body mass index, physical activity, and cigarette smoking. The inverse association between alcohol consumption and ESRD existed even after adjustment for systolic blood pressure, and history of diabetes and cardiovascular disease. Our results suggest an inverse relationship between alcohol consumption and risk of ESRD in Chinese men. Heavy alcohol consumption, however, may lead to increased risk of morbidity and mortality from other causes; therefore, the implications from these findings should be interpreted cautiously.