Alluvial riverbed elevation responds to the balance between sediment supply and transport capacity, which is largely dependent on climate and its translation into fluvial discharge. We examine these relations using U.S. Geological Survey streamflow and channel measurements in conjunction with basin characteristics for 915 reference ("least disturbed") measurement stations across the conterminous United States for the period A.D. 1950–2011. We find that (1) 68% of stations have bed elevation change ( BEC ) trends (p 〈 0.05) with median values of +0.5 cm/yr for aggradation and –0.6 cm/yr for degradation, with no obvious relation to drainage basin structure, physiography, or lithology; (2) BEC correlates with drainage basin area; (3) high-flow variability ( Q 90 / Q 50 , where Q is discharge and 90 and 50 are annual flow percentiles) translates directly into the magnitude, though not the direction, of BEC , after accounting for the scale dependence; (4) Q 90 / Q 50 declines systematically from dry to wet climates, producing disproportionately high rates of BEC in drier regions; and (5) marked increases in precipitation and streamflow occurred disproportionately at dry sites, while streamflow declined disproportionately at wet sites. Climatic shifts in streamflow have the potential to increase/decrease sediment flux and thus affect riverbed elevation by altering flood frequency. These unforeseen responses of bed elevation to climate and climate change have important implications for sediment budgets, longitudinal profiles, ecology, and river management.