Abstract: [Objective] To compare the clinical efficacy of Tibia Transverse Transfer (TTT) in the treatment of diabetic foot ulcer (DFU) patients with chronic kidney disease (CKD). [Methods] The clinical data of 120 patients with severe DFU (Wagner grade 3 or 4) admitted to our hospital were retrospectively analyzed. The patients were divided into the DFU+CKD group (n=67) and DFU group (n=53) according to the CKD status. , and 95.5% of patients had chronic kidney disease in stage III-V. There was no statistically significant differences between the two groups in age, gender proportion, duration of diabetic foot, foot gangrene rate, IDSA/IWGDF grade of ulcer infection, etc.(P>0.05). The ulcer healing rate, healing time, limb salvage rate, recurrence rate, survival rate and imaging and laboratory data were compared between the two groups. [Results] No serious complications were found for either group. All patients were followed up for 1 year. Seven patients in the DFU+CKD group died of cardiovascular and cerebrovascular diseases, and the survival rate was 89.6%. No patients in the DFU group died and the survival rate was 100% (P<0.05). For the DFU+CKD group, the healing rate of the surviving patients was 91.7%, the healing time was 4.7±2.9 months, the limb salvage rate was 90%, and the recurrence rate was 11.7%.For the DFU group, the healing rate was 94.3%, the healing time was 3.1±1.7 months, the limb salvage rate was 96.2%, and the recurrence rate was 1.9%. There was no significant differences in healing rate, limb salvage rate, and recurrence rate between the groups (P>0.05).The DFU+CKD group had significant longer healing time than the DFU groups (P<0.05). Computed tomography angiography (CTA) showed that the DFU+CKD group had more small vessels 1 month postoperatively than preoperatively. Moreover, the DFU+CKD group had lower CRP, creatinine, and HbA1c and higher endogenous creatinine clearance rate 1 month postoperatively than preoperatively. [Conclusion] Treatment of DFU with CKD using TTT resulted in high ulcer healing rate and limb salvage rage. The mechanism is probably related to the formation of neovascularization at the foot stimulated by TTT.