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The balance of R A and R E, a major determinant of intraglomerular pressure (P< glo), may be important in the initiation and progression of diabetic kidney disease (DKD). Although R A and R E are not directly measurable in humans these parameters can be estimated by the Gomez equation using measures of whole-kidney GFR and renal plasma flow (RPF), mean arterial pressure (MAP), hematocrit, and plasma oncotic pressure. We examined the association of the R A/R E ratio with ESKD incidence in 212 Pima Indians with T2D who underwent measures of GFR (iothalamate) and RPF (p-aminohippurate). R A/R E ratio’s association with kidney structural lesions was also examined in a subset of 111 participants. Of the 212 subjects (29% men; mean age 52 years, diabetes duration 22 years, MAP 92 mmHg, HbA1c 10.1%, GFR 111 ml/min; median ACR 99 mg/g), 57 progressed to ESKD during median follow-up …