Climate change and the associated increase in hydroclimatic extremes necessitate a deeper understanding of the resulting water quality responses. This study investigates the combined impacts of hydroclimatic extremes and land uses on water quality of the Chinese Jialing River, of which the middle and downstream areas experienced a flood in 2021 and a severe drought in 2022. Water Quality Index (WQI) and nutrient loads were assessed using daily data from 22 monitoring stations across the Jialing River and its two tributaries, the Qujiang River and Fujiang River, over 2021–2022. The results indicate a slight upward trend in water quality, as reflected by the WQI, for the tributaries from 2021 to 2022, while a declining trend was observed in the mainstream. Floods had a more pronounced impact on water quality than droughts, particularly on nutrient concentrations, and both dilution and flushing effects were observed as discharge increased in the Jialing River and its tributaries. Notably, water quality deterioration was most pronounced in the downstream areas with land uses dominated by cropland and built-up area, where intensified rainfall distributed and exacerbated nutrient losses in the rainy seasons. Nutrient fluxes, including Chemical Oxygen Demand (COD), Total Phosphorus (TP), and Total Nitrogen (TN), were closely linked to discharge, with hydroclimatic extremes therefore significantly affecting nutrient exports. This study elucidates the complex interactions between land use, extreme weather and water quality in the Jialing River Basin. Our findings underscore the need to strengthen the management of non-point source pollutants in the downstream areas of the Jialing River to address the challenges posed by anticipated increases in extreme rainfall in the near future.