ntroduction: N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a novel marker of cardiac disease and heart failure; both are in patients with diabetes and chronic kidney disease. Objectives: This study aimed to investigate the NT-proBNP and adverse outcome in patients with diabetes complicated by chronic kidney disease (CKD). Patients and Methods: We measured the serum levels of NT-proBNP. The association of this novel marker with re-hospitalization and mortality rate were prospectively compared among the studied groups. Results: Among 120 patients, baseline NT-proBNP at the time of admission was significantly elevated in patients with CKD (P = 0.001). Levels of NT-proBNP were significantly elevated in patients with diabetes and CKD than those with CKD alone (P = 0.04) at the end of follow-up. Higher proBNP levels significantly correlated with decreased glomerular filtration rate (GFR) and higher serum creatinine levels (P = 0.03, P < 0.001, respectively). In addition, increased mortality was noticed in those patients. Conclusion: NT-proBNP levels have prognostic implication in the setting of CKD, diabetes mellitus and heart failure. Adverse outcomes are; a higher rate of need for dialysis, rehospitalization and increased mortality which are correlated with levels of NT-proBNP