Background: Diabetic retinopathy and diabetic kidney disease are microvascular complicationsrnof diabetes mellitus. Patients with diabetic retinopathy are prone to develop diabetic kidneyrndisease. However, there is limited evidence on the relationship between diabetic retinopathyrnstages and diabetic kidney disease severity. rnrnObjective: To identify the relationship between patterns of diabetic retinopathy and diabeticrnkidney diseasernrnMethods: A hospital based cross-sectional study was conducted at diabetes clinic of TASH,rnEthiopia from June 2021 to July 2021. Structured questionnaire, patientsâ€™ charts and/or electronicrnmedical records were used to collect data among 101 diabetic patients with diabetic retinopathyrnaged 18 years and above. Data were cleaned, coded and entered into IBM SPSS version 26rnsoftware for analysis. Descriptive and logistic regression analyses were used and P-value < 0.05rnwas used as statistically significant.rnrnResults: The mean (Â±SD) age of the participants was 52.9 (Â±11.8) years. Majority (94.1%) ofrnour diabetic retinopathy patients had nonproliferative retinopathy and 70.3% of diabeticrnretinopathy patients had concomitant diabetic kidney disease. In multivariable logistic regressionrnanalyses, diabetic retinopathy severity (severe nonproliferative diabetic retinopathy tornproliferative diabetic retinopathy vs. mild to moderate nonproliferative diabetic retinopathy)rn[AOR= 3.97; 95% CI: 1.01 - 15.62], T2DM [AOR= 3.74; 95% CI: 1.29 - 10.75], presence ofrnCVD [AOR= 3.18; 95% CI: 1.05- 9.59] were the independent predictors of diabetic kidneyrndisease.rnConclusions: In this study, diabetic retinopathy severity was strongly associated with diabeticrnkidney disease. Therefore, evaluation of diabetic retinopathy severity at the time of retinalrnscreening is recommended.rnBudget grant: Addis Ababa University (AAU), College of Health Sciences, School of Medicine