Abstract: Objective To investigate the correlation of monocyte/high-density lipoprotein ratio （MHR） and urinary albumin/creatinine ratio （UACR） with the severity and prognosis of diabetic kidney disease （DKD）. Methods A total of 115 DKD patients treated in Bengbu Second People's Hospital from May 1, 2021 to May 1, 2022 were prospectively enrolled. They were divided into stage 1 group, stage 2 group, stage 3 group and stage 4 group according to the degree of renal pathological injury. MHR and UACR of each group were compared, and Spearman correlation analysis was used to evaluate the correlation of MHR and UACR with DKD severity. After discharge, patients were followed up by outpatient visit or telephone contact for 1 year. According to whether they developed end-stage renal disease （ESRD）, the patients were divided into good prognosis group and poor prognosis group. Logistic multivariate regression analysis was used to identify the risk factors for the prognosis of DKD patients. The receiver operating characteristic curve （ROC） was plotted to evaluate the efficacy of MHR and UACR in predicting the poor prognosis of DKD. Results There were significant differences in MHR and UACR among DKD patients with different stages （P<0.05）. The lowest MHR and UACR were detected in stage 1 group （5.35 ± 0.45） and （10.62 ± 2.15）, respectively, and the highest values were found in stage 4 group （9.35 ± 1.02） and （200.50 ± 40.58）, respectively. Spearman correlation analysis showed that MHR and UACR were positively correlated with the severity of DKD （r=0.867, 0.905, P<0.05）. There were significant differences in HBA1c （9.71 ± 1.08）% vs（12.95 ± 1.17）%, total cholesterol （4.80 ± 0.85） mmol/L vs（8.56 ± 1.75） mmol/L, triglyceride （1.46 ± 0.22） mmol/L vs（3.46 ± 0.52） mmol/L, serum creatinine （89.12 ± 10.30） μmol/L vs（170.44 ± 22.85） μmol/L, serum uric acid （5.18 ± 0.75） μmol/L vs（7.96 ± 1.16） μmol/L, cystatin C （0.90 ± 0.15） mg/L vs（1.88 ± 0.42） mg/L, low density lipoprotein （1.89 ± 0.46） mmol/L vs （3.85 ± 0.69） mmol/L, MHR （4.38 ± 0.29） vs（11.05 ± 0.85） and UACR （21.69 ± 4.10） vs （170.16 ± 26.50） between good and bad prognosis groups （P<0.05）. Logistic multivariate regression analysis showed that hemoglobin A1c （OR=2.344, 95% CI： 1.925-2.764）, total cholesterol （OR=2.208, 95% CI： 1.940-2.476）, triglyceride （OR=2.234, 95% CI： 1.986-2.363）, serum creatinine （OR=2.328, 95% CI： 2.025-2.631）, serum uric acid （OR=2.351, 95% CI： 2.082-2.621）, cystatin C （OR=2.363, 95% CI： 2.071-2.655）, low density lipoprotein （OR=2.421, 95% CI： 2.165-2.676）, MHR （OR=2.489, 95% CI： 2.109-2.870）, UACR （OR=2.537, 95% CI： 2.106-2.968） were independent risk factors for poor prognosis of DKD. The above indicators were all correlated with the prognosis of DKD. ROC curve showed that the sensitivity and AUC of MHR combined with UACR in predicting the poor prognosis of DKD were 90.50% and 0.896, respectively, which were significantly higher than those of MHR （84.50%, 0.871） and UACR （82.50%, 0.853） alone. Conclusion MHR and UACR are correlated with DKD severity and patient prognosis, and the combination of MHR and UACR is more effective in predicting poor prognosis of DKD.