Objective: We investigated factors that might influence the development of chronic kidney disease (CKD) in patients with type 2 diabetes. Methods: From January 2000 to December 2002, a total of 1,367 patients with type 2 diabetes without CKD (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73 m²) were consecutively enrolled. Patients were devided into two groups according to their baseline serum Lp(a) levels (Lp(a) > 30 mg/dL vs Lp(a) ≤ 30 mg/dL). The estimated GFR was measured annually, and new onset CKD was defined as eGFR < 60 mL/min/ 1.73 m² using a Modification of the Diet in Renal Disease formula. Results: Of the 1,367 patients who were enrolled in this study, 904 (66.1%) completed the follow-up evaluation. The median follow-up time was 9.8 years. The mean age was 56.0 ± 10.3 years, and the duration of diabetes was 8.5 ± 6.9 years. The baseline eGFR was 98.3 ± 25.6 mL/min/1.73m2. During the follow-up period, 234 patients (25.9%) progressed to chronic kidney disease. The patients in the CKD group were older (P < 0.001), had hypertension (P < 0.001), a longer duration of diabetes (P < 0.001), higher baseline A1C levels (P < 0.001), higher rates of albuminuria (P < 0.001), and received more insulin and ACE inhibitor treatment (P < 0.001). A Cox hazard regression analysis revealed that the development of CKD was significantly associated with the high level of serum Lp(a) level (Lp(a) > 30 mg/dL vs Lp(a) ≤ 30 mg/dL: hazard ratio 3.4; 95% CI 2.50 - 4.54; P < 0.001) after adjusting for sex, age, diabetic duration, mean A1C, albuminuria, treatment of insulin, ACE inhibitor/ARB and lipid lowering agents. Conclusion: In conclusion, the development of CKD from normal renal function was independently associated with serum Lp(a) level in patients with type 2 diabetes.