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Background The incidence of acute kidney injury (AKI) remains high in elderly patients with ST-segment elevation myocardial infarction (STEMI).In STEMI patients the development of AKI following primary PCI has previously demonstrated to be associated with prolonged in-hospital stay and increased long-term mortality.Comprehensive risk assessment for AKI this group of patients is of great importance.This study was to identify the risk factors of developing AKI and investigated its impact on prognosis.Methods A total of 550 patients with STEMI were enrolled from January 2010 to December 2018 and divided into two groups according to whether developing AKI: Non-AKI group (n=460) and AKI group (n=90).Multivariate regression was used to determine independent risk factors for AKI or one-year death.Results 90 (16.4％) patients suffered AKI.Multivariate logistic regression showed that anemia (HR: 2.092,95％ CI: 1.141-3.837,P=0.017) and lgNT-pro-BNP (HR: 2.644,95％ CI: 1.409-4.960,P=0.002) were independent predictors of the incidence of AKI in elderly patients with STEMI.526 (95.6％) patients completed one-year follow-up.Kaplan-Meier survival curves showed that patients with AKI had a worse prognosis than those without AKI (Log-rank test=48.51,P＜0.001).Multiple Cox analysis showed that AKI was associated with increased risk of one-year death (HR: 2.742,95％ CI: 1.525-4.929,P=0.001).Conclusions AKI occurred frequently in elderly patients with STEMI and was associated with poor outcomes.Attention should be paid to those patients with anemia and cardiac dysfunction,which were more likely to develop AKI.