Background/aim: Acute kidney injury (AKI) is a serious morbidity in premature neonates. The aim of this study was to determine the incidence of AKI and to evaluate its impact on morbidity and mortality in very premature infants. Materials and methods: This retrospective cohort study was conducted in the neonatal intensive care unit (NICU). A total of 410 preterm infants who were born before 32 gestational weeks were screened and 318 were included in this analysis. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria. Results: The incidence of AKI was 32.1% (102/318). Regression analyses revealed that lower gestational age, vasopressor use, and hemodynamically significant patent ductus arteriosus were significantly associated with an increased risk for AKI. After adjustment for potential confounders, those with AKI had a higher risk of death before 36 weeks of corrected gestational age (adjusted hazard ratio: 3.02, 95% confidence interval 1.47- 6.22). Additionally, the AKI group had a higher rate of bronchopulmonary dysplasia (BPD) (46% vs. 24%, p < 0.001) and longer hospital stay with a mean difference of 38 days. Conclusion: AKI is common in very premature neonates and associated with higher mortality, longer hospital stay, and BPD. Identification of risk factors and preventive strategies for AKI may improve the outcomes in this vulnerable population.