Background: Acute kidney injury (AKI) is a major complication of cardiac surgery, with high rates of morbidity and mortality. The aim of this study was to identify risk factors for the incidence and prognosis of AKI in high-risk patients before and after surgery for acute type A aortic dissection (TAAD) in the intensive care unit (ICU). Methods: We performed a retrospective cohort study from April 2018 to April 2019. The primary end points of this study were morbidity due to AKI and risk factors for incidence, and the secondary end points were mortality at 28 days and risk factors for death. Results: We enrolled 60 patients, 52 (86.67%) patients developed postoperative AKI, 28 (53.84%) patients died. Preoperative lactic acid level (P=0.022) and cardiopulmonary bypass (CPB) duration (P=0.009) were identified as independent risk factors for postoperative AKI. The 28-day mortality for postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, 67.5% for those who required continue renal replacement therapy (CRRT). The risk factors for 28-day mortality due to postoperative AKI for patients requiring CRRT were CPB duration (P=0.019) and norepinephrine dose upon diagnosis of AKI (P=0.037). Conclusions: Morbidity due to AKI in postoperative patients with TAAD was 86.67%, and preoperative lactic acid level and CPB duration were independent risk factors. The 28-day mortality of postoperative patients with TAAD was 46.67%, 53.84% for those with TAAD and AKI, and 67.5% for those requiring CRRT. CPB duration and norepinephrine dose upon diagnosis of AKI may influence patients' short-term prognosis.