PURPOSE: Diabetic kidney disease (DKD) significantly affects health and healthcare costs due to chronic kidney disease complications. Given asprosin's potential as a biomarker for disease progression, we conducted the first systematic review and meta-analysis on its relationship with DKD in adults with type 2 diabetes mellitus (T2DM). METHODS: PubMed, Embase, Cochrane, and Web of Science were systematically searched. Standard mean differences (SMD) with 95% confidence intervals (CI) and Fisher's Z transformation were used to examine the relationship between asprosin and DKD. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) and its version for cross-sectional studies. Heterogeneity (I² > 50%) was analyzed with a random-effects model. RESULTS: Six studies (n = 1340) were included. Meta-analysis results indicated that T2DM patients with DKD (micro/macroalbuminuria) had significantly higher circulating asprosin levels than normoalbuminuric T2DM patients (SMD: 1.5, 95% CI: 0.69-2.32, p = 0.0003). Meta-analysis of correlation revealed a positive association of asprosin with urinary albumin excretion ratio (UACR) (Fisher's Z = 0.4; 95% CI: 0.240-0.554, p < 0.001) and body mass index (BMI) (Fisher's Z = 0.17; 95% CI: 0.036-0.301, p = 0.013), and a negative association with estimated glomerular filtration rate (eGFR) (Fisher's Z = -0.35; 95% CI: -0.471 to -0.239, p < 0.001). CONCLUSION: Asprosin is elevated in T2DM patients with pre-DKD (early stage DKD) and DKD and correlates with key markers of disease severity. Additional research is required to better understand the pathophysiological mechanisms of asprosin and its role in DKD.