Objective To establish a nomogram based on the risk model of diabetic kidney disease (DKD) proposed by National Health Commission Key Laboratory of Hormones and Development, in order to identify high-risk DKD patients who may experience progression within two years. Methods This study was a prospective cohort study that selected patients with type 2 diabetes mellitus who met the high-risk criteria for DKD and followed them for two years. Patients who experienced DKD progression during the follow-up period were defined as the DKD group, while those who did not were defined as the non-DKD group. Clinical baseline data and ultrasound indicators of the selected patients were analyzed using uni- and multi-variate Cox regression analysis, and a nomogram model was established to predict the risk of disease progression in high-risk DKD patients within two years. Results By the end of the follow-up, there were 63 patients in the DKD group and 308 patients in the non-DKD group. Survival analysis showed that the proportion of high-risk DKD patients who experienced progression within 2 years was 16.98%. Multivariate Cox regression analysis found that the duration of diabetes, interlobar resistance index, and the presence of diabetic retinopathy and hypertension were independent factors influencing disease progression in high-risk DKD patients within 2 years (all P < 0.05). The nomogram model based on these four indicators had good discrimination (area under the curve, AUC: 0.783), and its predictive accuracy was higher than that of each individual predictor alone (P < 0.05). In addition, the probability of DKD progression predicted by the nomogram was consistent with the actual incidence (χ²=6.392, P=0.592), and it had a good net benefit, indicating its good clinical application value in decision-making. Conclusion This study established a nomogram incorporating four common indicators to identify high-risk DKD patients who may progress within two years, enabling early intervention during the "subclinical" stage before urinary microalbuminuria elevation. This nomogram had the potential to delay or even prevent high-risk patients from further progressing to DKD.