To explore the relationship between dietary patterns and risk of chronic kidney disease (CKD) in Chinese adults aged 45-59 years. Dietary data were collected using a semi-quantitative FFQ. Factor analysis was used to identify the major dietary patterns. Logistic regression models were applied to clarify the association between dietary patterns and the risk of CKD. The present study population was a part of the population-based Nutrition and Health Study performed in the city of Hangzhou, Zhejiang Province, eastern China. A total of 2437 eligible participants (45-59 years) were enrolled in the present cross-sectional study from June 2015 to December 2016. Three major dietary patterns were identified: 'traditional southern Chinese', 'Western' and 'grains-vegetables' patterns, collectively accounting for 25·6 % of variance in the diet. After adjustment for potential confounders, participants in the highest quartile of the Western pattern had greater odds for CKD (OR = 1·83, 95 % CI 1·21, 2·81; P < 0·05) than those in the lowest quartile. Compared with the lowest quartile of the grains-vegetables pattern, the highest quartile had lower odds for CKD (OR = 0·84, 95 % CI 0·77, 0·93; P < 0·05). In addition, there was no significant association between the traditional southern Chinese pattern and risk of CKD (P > 0·05). Our results suggest that the Western pattern is associated with an increased risk, whereas the grains-vegetables pattern is associated with a reduced risk for CKD. These findings can guide dietary interventions for the prevention of CKD in a middle-aged Chinese population.