Modifiable risk factors such as systolic blood pressure, low-density lipoprotein cholesterol level, tobacco smoking, and diabetes account for a percentage of the incidence of end stage kidney disease (ESKD); however, the percentage varies according to the populations studied and the methods used. We examined the effect of modifiable risk factors on ESKD. A population-based cohort study using the Korean National Health Insurance Service database (n = 6,842,447) analysed patients with no ESKD history who underwent health screenings between 2009 and 2010. The primary endpoint for this study was incident ESKD, defined using a combination of ICD-10 codes and the procedure code of renal replacement therapy during hospitalization. Population-attributable fractions were estimated for the 10-year incidence of ESKD. Among 6,842,447 participants (48.4% of whom were women) with a median age of 58 years, incident ESKD occurred in 35,457 participants during a median follow-up of 13 years. For all four risk factors combined, the aggregate population-attributable fraction of the 10-year incidence of ESKD was 49.7% (95% confidence interval [CI], 39.4 to 58.9) among women and 46.9% (95% CI, 38.7 to 54.4) among men. The population-attributable fraction of the 10-year incidence of ESKD associated with systolic blood pressure was 45.8% among women and 20.3% among men; the corresponding values were 0.7% and 1.4% for ESKD associated with non-HDL cholesterol level. The population-attributable fraction of the 10-year incidence of ESKD among women was 14.4% for diabetes and 2.6% for current smoking; the corresponding values among men were 22.9% and 13.8%. Our data showed that 49.7% and 46.9% cases of incident ESKD among women and men, respectively, may be attributable to four modifiable risk factors. Among the four risk factors studied, elevated systolic blood pressure was the largest contributor to the population-attributable fraction of incident ESKD and thus may offer the greatest potential for prevention.