Background: Fetuin-A is a pro-inflammatory cytokine related to insulin resistance. Increased fetuin-A in urine is linked to reduced renal function. It is unknown whether it is a generic marker of damage or a more specific one able to differentiate DKD-Ph. Materials and methods: In 256 T2DM, we stratified; diabetic kidney disease phenotypes (DKD-Ph) by urinary albumin-to-creatinine ratio (uACR, ≥30 mg/g) and/or eGFR (<60 ml/min/1.73m2). Recruitment was planned to obtain evenly sized groups. Fetuin-A was measured (DNLite-IVD103 ELISA) in morning urines and adjusted for urine creatinine (ng/mg, uFCR). Results: Overall, 26.2% had no-DKD, 24.6% increased uACR only (Alb+), 24.2% non-albuminuric DKD (Alb-DKD) and 25.0% albuminuric DKD (Alb+DKD). uFCR correlated with uACR (r=0.529, p<0.0001), inversely with eGFR (r=-0.266, p<0.0001), but also with DD, SBP, HbA1c, HDL (inversely) and fibrinogen. Compared to normo- (n=127; 6.83, IQR 3.14-17.59), uFCR increased in micro- (n=81; 13.00, 5.56-27.36, p=0.006) and macroalbuminurics (n=43; 94.71, 39.17-248.53, p<0.0001). Also, uFCR increased from eGFR G1-G2 (n=126; 9.93, IQR 3.63-21.96) to G3 (n=117; 16.21, 4.74-54.14, p=0.023) and G4 (n=8; 223.90, 158.30-442.99, p<0.0001), and differed by DKD-Ph (p<0.0001): no-DKD 6.80 (3.01-15.16), Alb+ 13.37 (5.02-40.04, p=0.003), Alb-DKD 7.02 (3.37-19.40, p=0.865) and Alb+DKD 47.40 (13.83-123.06, p<0.0001). In logistic regression, uFCR was a covariate of uACR ≥30 (OR 1.84, 95%CI 1.49-2.26, p<0.0001) regardless of age, sex, DD, BMI, HbA1c, hypertension, dyslipidemia, RAS-blockers and eGFR. Again, it was associated with eGFR<60 (OR 1.34, 1.28-1.61, p=0.001) adjusting for the same covariates and uACR. Compared to no-DKD, uFCR was a covariate of Alb+ (OR 1.38, 1.03-1.86, p=0.029) and Alb+DKD (2.97, 1.91-4.64, p<0.0001), but not of Alb-DKD (p=0.433). Finally, Alb+ (OR 2.14, 0.99-4.63, p=0.054) and Alb+DKD (6.42, 2.77-14.88, p<0.0001), not Alb-DKD (p=0.863), were covariates of uFCR above median. Conclusions: uFCR is increased to a larger extent in albuminuric DKD-Ph and its levels are associated with the albuminuric state in T2DM. Therefore, uFCR may improve characterization of DKD-Ph in T2DM. Funding: PRIN 2020 (2020SH2ZZA).