Background <p>Diabetic kidney disease (DKD) is one of the most prevalent and severe microvascular complications of diabetes, with growing morbidity and mortality. The dysbiosis of gut microbiota exhibits a robust correlation with DKD pathogenesis. Recently, a growing body of researches have significantly advanced our comprehension of the gut microbiota’s role in influencing the onset, progression, prevention, and therapeutic strategies for DKD.</p> Methods <p>We performed a comprehensive literature search across multiple scientific databases to investigate the relationship between gut microbiota and DKD, the role of gut dysbiosis in DKD pathogenesis, and novel gut-kidney axis-based therapeutic approaches. The selection of the articles are based on relevance to the research topic, methodological rigor, and contribution to the field.</p> Results <p>Our review demonstrates that gut microbiota in DKD patients exhibits distinct compositional alterations compared to healthy individuals, characterized by reduced microbial diversity, altered abundance, and taxonomic shifts at genus/species levels. Mechanistically, gut microbiota influences DKD through multiple pathways: inflammatory activation, epithelial barrier dysfunction, vascular hyperpermeability, and metabolite-mediated signaling. Crucially, the imbalance of gut microbiota may initiate or accelerate DKD pathogenesis, whereas short-chain fatty acids, probiotics and dietary interventions demonstrate protective effects against disease onset and progression.</p> Conclusion <p>Microbiota-targeted intervention represents a promising therapeutic strategies for DKD management.</p>