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Abstract: Background: Renal function decline in diabetic kidney disease is accompanied by calcium and phosphate metabolism alterations. Whereas strontium (Sr2+) has many similarities with calcium, little is known about Sr2+ in this respect. We studied the association of plasma Sr2+ concentration and parameters associated with an altered calcium and phosphate metabolism in diabetic kidney disease. Materials and methods: Plasma Sr2+ concentration was measured in 450 patients included in the DIAbetes and LifEstyle Cohort Twente‐1. Patients were classified based on chronic kidney disease (CKD) stages: stages 1‐2, stage 3 and stages 4‐5 (estimated glomerular filtration rate of ≥60 mL·min−1·1.73 m−2, 30‐59 mL·min−1·1.73 m−2 and ≤29 mL·min−1·1.73 m−2, respectively). The associations between log‐transformed plasma Sr2+ concentration and parameters of calcium and phosphate metabolism were studied using multivariate linear regression analysis. Results: Overall, median plasma Sr2+ concentration was in normal range, 269 nmol/L, but was progressively higher in patients with lower renal function, that is 246 nmol/L (CKD 1‐2), 347 nmol/L (CKD 3) and 419 nmol/L (CKD 4‐5). In multivariate analysis, independent associations were found between plasma Sr2+ concentration and both eGFR (β = −0.401, P < 0.001) and plasma fibroblast growth factor 23 (FGF23) concentration (β = 0.087, P = 0.04). Conclusions: We found an independent inverse association between eGFR and plasma Sr2+ concentration and an independent association between plasma Sr2+ concentration and plasma FGF23 concentration, a marker of deranged calcium and phosphate metabolism. Further research is needed to determine the mechanisms behind these associations and the impact of an elevation in plasma Sr2+ concentration on bone mineralization and calcification. [ABSTRACT FROM AUTHOR]