Objective <p>While Pan-Immune-Inflammation Value (PIV) has been associated with chronic kidney disease of various etiologies, there is a lack of studies specifically analyzing the relationship between PIV and diabetic kidney disease (DKD) in individuals with type 2 diabetes mellitus (T2DM). This study aimed to explore the association between PIV and DKD.</p> Methods <p>The data were obtained from Guang’anmen Hospital and 38 community health service centers, spanning the period from 2014 to 2022. This study conducted a cross-sectional study including 7,610 T2DM patients and a cohort study comprising 1,494 T2DM patients without baseline kidney disease. In both studies, multivariable-adjusted logistic regression models and restricted cubic spline (RCS) analyses were used to assess the relationship between PIV and DKD.</p> Results <p>In the cross-sectional study, after adjusting for potential confounders, PIV was significantly and positively associated with DKD prevalence in T2DM patients, with those in the highest quartile exhibiting a 76.3% higher prevalence compared to the lowest quartile. In the cohort study, even after controlling for multiple confounding factors, higher PIV levels remained significantly associated with an increased risk of DKD, with the highest quartile showing a 131.3% higher incidence than the lowest quartile. Furthermore, the relationship between PIV and DKD incidence followed an inverse J-shaped pattern, and this association was largely consistent across most subpopulations.</p> Conclusion <p>In individuals with type 2 diabetes, higher PIV levels are associated with an increased risk of developing diabetic kidney disease (DKD), highlighting the potential of PIV as a marker for identifying DKD risk in T2DM patients.</p> Clinical trial number <p>Not applicable.</p>