Greater adherence to the Mediterranean diet has beneficial effects on the prevention of chronic diseases. In the current study, we investigated the association between the Mediterranean diet score (MDS) and the 6-year incidence of chronic kidney disease (CKD), conducted in the framework of the Tehran Lipid and Glucose Study with 1212 adults, aged 30-71 years. Dietary intake was assessed using a valid and reliable food-frequency questionnaire, and all subjects received scores between 0 and 8 points based on the traditional MDS. The components of the MDS were fruits and nuts, vegetables, legumes, cereals, fish, meat, dairy products and the monounsaturated to saturated fatty acid ratio. The odds ratio (OR) for the occurrence of CKD according to the quartiles of the MDS was assessed by multivariable logistic regression. The mean (s.d.) age of participants (51% male) at baseline was 43.5 (9.4) years. The median (25-75 interquartile range) of MDS for all subjects was 4 (3-5).The incidence of CKD was 19%. After adjustment for all potential confounding variables, individuals in the highest quartile of the MDS were 51% less likely to have CKD than those in the lowest quartile (OR=0.49; 95% confidence interval (CI): 0.30-0.82). Additionally, after further adjustment for baseline estimated glomerular filtration rate (GFR), the inverse association between the MDS and the 6-year incidence of CKD remained significant (OR=0.53; 95% CI: 0.31-0.91). Our findings demonstrate a significant inverse association between the MDS and the risk of incident CKD, indicating that adherence to the Mediterranean diet has favorable effects on the prevention of kidney dysfunction.