BACKGROUND: Incidence of Acute Kidney Injury (AKI) among Type 2 diabetic patients is significantly increasing. But, earlier studies has focused on the admitted patients which may hide the true nature of the Acute Kidney Injury among Type 2 Diabetic (T2D) patients. So, this study was conducted to determine the time to Acute Kidney Injury and its predictors among Type 2 Diabetic patients in Harari Region, East Ethiopia. METHODS: We conducted a retrospective cohort study among type 2 diabetic patients who had been receiving treatment at government hospitals of Harari region, Ethiopia from 2013 to 2017. We extracted data from patients' medical records. We estimated incidence rate and compared survival curves between different exposure groups using Kaplan-Meier and log-rank test. Weibull regression model was fitted to the data to identify the predictor variables. Variables with p-value <0.05 were considered statistically significant. RESULTS: Overall, 14.5% (95%CI: 11.7-17.9) of the study population developed acute kidney injury, with median survival time of 57 months. The significant predictors were physical activity [Adjusted Time Ratio (ATR):95%CI; 0.6 (0.49-0.75)], congestive heart failure [ATR:95%CI; 0.84 (0.71-0.99)], chronic kidney disease [ATR:95%CI; 0.77(0.65-0.91)], hypertension [ATR:95%CI; 0.78(0.65-0.91)], obesity [ATR:95%CI; 0.84(0.74-0.96)], diabetic nephropathy [ATR:95%CI; 0.80(0.65-0.98)], diuretics & beta blockers [ATR:95%CI; 0.85(0.74-0.97)], and delay of follow-up [ATR:95%CI; 0.97(0.96-0.98)]. CONCLUSIONS: Incidence of acute kidney injury was high in our study area. Hence, identification and controlling of comorbidities along with regular monitoring of kidney function are needed to prevent or delay the risk of acute kidney injury in type 2 diabetic patients.