["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nAlcohol use disorder (AUD) is a chronic, relapsing psychiatric condition that contributes substantially to global morbidity. Although the health consequences of alcohol consumption have been widely studied, the association between AUD and incident end‐stage kidney disease (ESKD) remains unclear.\n\n\nDesign\nNationwide population‐based cohort study.\n\n\nSetting and participants\nWe analyzed 4 595 974 Korean adults who completed the 2012 national health screening and were followed until 2022 (median follow‐up, 9.4 years).\n\n\nMeasurements\nAUD was defined as at least one recorded International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD‐10) F10 code within 5 years before baseline. Baseline alcohol intake was assessed using a self‐reported questionnaire and categorized into four sex‐specific baseline drinking categories: 0–10, >10–30, >30–60 and >60 g/day for men, and 0–10, >10–20, >20–50 and >50 g/day for women. The primary outcome was incident ESKD. Multivariable time‐to‐event models assessed the associations of AUD and baseline alcohol intake with ESKD risk.\n\n\nFindings\nThe prevalence of AUD was 0.7% (n = 33 848). During follow‐up, 13 182 participants developed ESKD. AUD was associated with a higher risk of ESKD after full adjustment [hazard ratio (HR) = 1.50, 95% confidence interval (CI) = 1.31–1.72]. In competing‐risk analyses treating death as a competing event, this association remained statistically significant [subdistribution hazard ratio (sHR) = 1.63, 95% CI = 1.45–1.82]. Across the four baseline drinking categories from lowest to highest, the adjusted HRs for AUD vs. no AUD were 1.39 (95% CI = 1.17–1.66), 1.54 (95% CI = 1.13–2.11), 1.88 (95% CI = 1.32–2.67) and 1.73 (95% CI = 1.03–2.89), respectively, with no evidence of interaction (P for interaction = 0.4634). In joint‐category analyses, the highest risk was observed among those with both AUD and the highest baseline alcohol intake category, but there was no evidence of additive interaction. The association of AUD with ESKD was stronger among participants without baseline chronic kidney disease than those with (P for interaction = 0.0067).\n\n\nConclusions\nIn Korea, alcohol use disorder appears to be associated with a higher risk of incident end‐stage kidney disease independent of self‐reported baseline alcohol intake. These findings suggest that clinically identified alcohol use disorder may capture long‐term renal risks not fully reflected by a single baseline measure of self‐reported alcohol intake.\n\n"]