An adequate hydration seems to have a beneficial effect on the prevention of Chronic Kidney Disease (CKD) in the general population. In individuals with CKD, the associations between daily water intake and disease progression are unclear. The objective of this study was to investigate the association between pure water intake and the risk for end-stage kidney disease (ESKD) - requiring renal replacement therapy - in patients with moderate or advanced CKD. This study is based on 3032 patients from the national Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) that includes 40 nephrology clinics in France. Usual pure water intake at baseline (over a week) was assessed from patient interview. Cox models were used to estimate adjusted hazard ratios (HRs) and their 95% confidence intervals (CI) of ESKD associated with water intake divided into 5 classes: <0.5, 0.5-1, 1-1.5, 1.5-2.0, ≥2.0 L/d. In a sub-group of patients with baseline 24h urine collection (N=1271), we assessed the impact of adjusting for osmole excretion on this association. Patients’ median (IQR) age was 69 (60-76) years and eGFR, 31.8 (23.1-41.2) ml/min per 1.73m²; 35% were women and 43% had diabetes. Median (IQR) pure water intake at baseline was 1.5 (1.0-2.0) L/day. There was no difference in water intake according to CKD stage (p=0.11). Percentages of patients according to the 5 water intake classes were 7, 29, 36, 18, and 11, respectively. An older age, female gender, lower BMI, lack of dietician visit, and cardiovascular history were associated with lower water intake whereas high educational level, and living in the South of the France were associated with higher water intake. Over a median follow-up of 3.0 years (IQR, 2.0-3.2), 480 patients progressed to ESKD. As compared to patients with medium water intake (1-1.5L/d), adjusted HRs[CI] for ESKD were 1.24[0.83-1.86], 1.20[0.95-1.52], 1.17[0.89-1.53] and 1.29[0.97-1.72] for water intakes of <0.5, 0.5-1, 1.5-2.0, and ≥ 2.0L/d, respectively. In the subgroup, adjusted HRs were somewhat stronger, 1.55[0.87-2.78]. 1.53[1.05-2.25], 1.36[0.88-2.08] and 2.45[1.56-3.85] for <0.5, 0.5-1, 1.5-2.0 and ≥ 2.0L/d, respectively, despite similar median water intake and ESKD rate than the overall population. Osmole excretion rate decreased with decreasing eGFR, but adjusting for this variable did not modify the association: 1.48[0.82-2.66], 1.51[1.03-2.21], 1.35[0.88-2.08], 2.44[1.56-3.84] for each water intake class compared to patients with medium water intake. This study did not show an association between baseline pure water intake and CKD progression to end-stage. Further analyses are needed taking longitudinal water intake into account.