The association between incident chronic kidney disease (CKD) or end-stage renal disease (ESRD) and exposure to outdoor air pollution is under debate. We aimed to examine this relationship based on a systematic review with random-effects meta-analysis. We screened the literature on long-term air pollution exposure assessment in the general population using an electronic search of PubMed, Medline, Embase, and Cochrane Library from inception to 20 October 2019. Observational studies investigating the association between long-term exposure to gaseous (CO, SO2, NO2, O3) or particulate (PM2.5 or PM10) outdoor air pollutants and CKD, ESRD, or renal dysfunction were included, and summary risks were estimated. Of 4419 identified articles, 23 met our inclusion criteria after screening and 14 were included in the meta-analysis. Pooled effect estimates had the following summary risk ratios (RRs) for CKD: 1.10 (95% confidence intervals CI 1.00, 1.21; derived from four studies) per 10 μg/m3 increase in PM2.5 and 1.16 (95% CI 1.05, 1.29; derived from four studies) for PM10; 1.31 (95% CI 0.86, 2.00; derived from two studies) per 10 ppm increase in CO; and 1.11 (95% CI 1.09, 1.14; derived from three studies) per 10 ppb increase in NO2. For the pooled effect on eGFR, increases in PM10 and PM2.5 (of 10 μg/m3) were associated with eGFR decline by −0.83 (95% CI –1.54, −0.12; derived from two studies) and −4.11 (95% CI –12.64, 4.42; derived from two studies) mL/min/1.73 m2, respectively. Air pollution was observed to be associated with CKD and renal function decline. Although more longitudinal studies are required, we argue that air pollution is pernicious to kidney health. Forest plot and pooled estimates of the effect of air pollutants on the risk of chronic kidney disease. (The size of the gray boxes for each point estimate represents the size of the included study.) Display omitted •Long-term exposure to air pollutants, especially ambient PM and NO2, is associated with an increased risk of CKD.•PM2.5 substantially contributed to the global burden of CKD in 2016.•Considerable statistical heterogeneities were revealed in this meta-analysis.•An inverse relationship between the concentration of ambient air particulate matter and eGFR were identified.