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Objectives To assess factors associated with chronic kidney disease (CKD) awareness and preventive self-care among people living with diabetes at a national tertiary hospital in Tanzania.Design Hospital-based cross-sectional analytical study.Setting The study was conducted at the diabetic clinic of Muhimbili National Hospital in Tanzania.Participants A total of 271 patients attending the diabetic clinic were enrolled.Primary outcome measures Primary outcomes were awareness and preventive self-care regarding CKD among patients. Median scores were used to categorise awareness as either higher or lower and preventive self-care practices as either better or poorer. Factors associated with awareness and preventive self-care were analysed using logistic regression models.Methods Data were collected using a structured questionnaire capturing sociodemographic characteristics, CKD awareness and CKD preventive self-care practices. Bivariate and multivariable logistic regression analyses were performed to identify independent predictors.Results Among respondents, 114 (42.1%) had higher CKD awareness while 141 (52.0%) demonstrated better CKD preventive self-care practices. Younger age (<40 years; adjusted OR (AOR): 0.40; 95% CI 0.203 to 0.801; p=0.009), lower education level (AOR: 0.48; 95% CI 0.289 to 0.807; p=0.005) and rural residency (AOR: 0.52; 95% CI 0.300 to 0.917; p=0.024) were independently associated with lower CKD awareness. Conversely, respondents with fewer years of living with diabetes (<5 years; AOR: 2.05; 95% CI 1.173 to 3.592; p=0.012) and those with a family history of diabetes (AOR: 1.84; 95% CI 1.082 to 3.127; p=0.024) were more likely to have poorer CKD preventive self-care practices.Conclusion This study found low awareness and suboptimal CKD self-care among people living with diabetes. Awareness was associated with age, education level and residence, while self-care was associated with diabetes duration and family history. These findings highlight the need for early, structured education addressing CKD risk, misconceptions and culturally appropriate behaviour-change strategies to improve adherence.