Whilst there are longstanding and well-established inequalities in safe-drinking water-access between urban and rural areas, there remain few studies of changing intra-urban inequalities over time. In this study, we determined the spatio-temporal patterns of domestic piped water distribution in Nairobi, Kenya between 1985 and 2018, and the implications of socio-economic and neighbourhood inequalities in water sufficiency. Using data from the Nairobi water and sewerage utility company for the period 2008–2018, we examined the sufficiency of monthly domestic water consumption per capita for 2380 itineraries (areas with an average population of 700) in relation to a residential neighbourhood classification, population and neighbourhood age and also examined water rationing patterns by neighbourhood type. Water sufficiency differed by residential areas, age of neighbourhood and population per itinerary. Compared to residents of low-income areas, those in high- and middle-income areas were six and four times more likely to receive the recommended 1500 L per capita per month respectively. Newer neighbourhoods and less densely populated areas were more likely to receive higher volumes of water. Non-revenue water loss accounted for 29% (average 3.5 billion litres per month) of water distributed across Nairobi, and was more than two times the amount of water needed for all residents to access the recommended monthly per capita water consumption. The observed spatial inequality in distribution, and access to piped water associated with socio-economic status and neighbourhood age highlights the need for deliberate planning and governance to improve water distribution to match the speed of growth of low/middle- and low-income residential areas and enhance equity.