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Few studies have examined the effects of multi-pollutant air pollution on renal health, especially in children and adolescents. This study investigated the association between long-term ambient air pollution exposure and renal health in Asian children and adolescents. This study included 10,942 children and adolescents from Taiwan and Hong Kong between 2000 and 2017. PM 2.5 , NO 2 and O 3 concentrations were estimated using satellite-based spatiotemporal regression models. Two-year average concentrations, those of the year of visit and the preceding year, were used. Linear mixed models were used to examine the association between air pollution and yearly changes in estimated glomerular filtration rate (eGFR). Cox regression models with time-dependent covariates were used to examine the association between air pollution and the development of chronic kidney disease (CKD). Median age of the participants was 19 years (range: 2–25). The overall average concentration of PM 2.5 , NO 2 and O 3 was 26.7 μg/m3, 44.1 μg/m3 and 51.1 μg/m3, respectively. The mean yearly change in eGFR was 0.37 μL/min/1.73 m2 and the incidence rate of CKD was 6.8 per 1,000 person-years. In single-pollutant models, each 10 μg/m3 increase in PM 2.5 was associated with a 0.45 μL/min/1.73 m2 [95% confidence interval (CI): 0.28–0.63] reduction in the yearly increase in eGFR and 53% [hazard ratio (HR): 1.53 (95%CI: 1.07–2.2)] greater risk of incident CKD. Each 10 μg/m3 increase in NO 2 was associated with a 7% [HR (95%CI): 1.07 (1.00–1.15)] higher risk of incident CKD, while an equivalent increase in O 3 was associated with a 19% [HR (95%CI): 0.81 (0.67–0.98)] lower risk. Long-term exposure to ambient PM 2.5 and NO 2 was associated with a slower growth of eGFR and a higher risk of incident CKD in children and adolescents. Our findings suggest that air pollution control in early life is imperative to improve lifelong renal health and alleviate the CKD burden. • Novel study that investigated the associations between early-life exposure to air pollution and renal health in children. • Long-term exposure to ambient PM 2.5 and NO 2 was associated with a slower growth in eGFR and a higher risk of CKD. • Long-term exposure to ozone was associated with a lower risk of CKD. • Linear and monotonic concentration-response curves were found between air pollution and CKD. [ABSTRACT FROM AUTHOR]