A study investigated the association between the neutrophil-to-lymphocyte ratio (NLR) and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2020. The study found a positive correlation between NLR and the prevalence of DKD, albuminuria, and low estimated glomerular filtration rate (eGFR). NLR was also positively associated with other inflammatory markers such as monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and system inflammation response index (SIRI). ROC analysis showed that NLR had better discriminatory power and accuracy in predicting DKD, albuminuria, and low-eGFR compared to other inflammatory markers. Subgroup analysis revealed that the association between NLR and DKD was not significantly different across populations. The study concluded that NLR may serve as a more effective potential inflammatory marker for identifying the risk of DKD, albuminuria, and low-eGFR in US T2DM patients. T2DM patients with elevated levels of NLR, MLR, SII, and SIRI should be closely monitored for potential renal function risks. The study highlights the importance of NLR as a simple, affordable, and widely used inflammatory marker for assessing kidney health in T2DM patients.A study investigated the association between the neutrophil-to-lymphocyte ratio (NLR) and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2020. The study found a positive correlation between NLR and the prevalence of DKD, albuminuria, and low estimated glomerular filtration rate (eGFR). NLR was also positively associated with other inflammatory markers such as monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and system inflammation response index (SIRI). ROC analysis showed that NLR had better discriminatory power and accuracy in predicting DKD, albuminuria, and low-eGFR compared to other inflammatory markers. Subgroup analysis revealed that the association between NLR and DKD was not significantly different across populations. The study concluded that NLR may serve as a more effective potential inflammatory marker for identifying the risk of DKD, albuminuria, and low-eGFR in US T2DM patients. T2DM patients with elevated levels of NLR, MLR, SII, and SIRI should be closely monitored for potential renal function risks. The study highlights the importance of NLR as a simple, affordable, and widely used inflammatory marker for assessing kidney health in T2DM patients.