Findings demonstrate a high AKI-associated mortality, as greater than one in four patients with AKI died within 1 year of hospitalization. Over the past decade, no significant progress appears to have occurred toward improving in-hospital or long-term AKI survivorship.

• In this retrospective cohort study utilizing data on 1,688,457 patients and 2,689,093 hospitalizations from the national Veterans Health Administration, the trends in in-hospital and 1-year mortality linked with AKI as defined by Kidney Disease Improving Global Outcomes consensus criteria were analyzed.

• Of AKI patients, in-hospital deaths occurred in 6%, and death occurred within 1 year in 28%.

• In non-AKI hospitalizations, in-hospital and 1-year death rates were 0.8% and 14%, respectively.

• A slight decrease in crude in-hospital AKI-associated mortality (hazard ratio, 0.98 per year) was observed during the study period, that was attenuated post-accounting for patient demographics, comorbid conditions, and acute hospitalization features (adjusted hazard ratio, 0.99 per year).

• Persistence of this stable temporal trend in mortality was noted at 1 year (adjusted hazard ratio, 1.00 per year).