Background: Information on acute kidney injury (AKI) in elderly hospitalized patients is limited. This study aims to assess the incidence, risk factors and outcomes of AKI in elderly Chinese patients. Method: The Epidemiology of AKI in Chinese Hospitalized adults (EACH) study is a multicenter, retrospective cohort study conducted in nine regional central hospitals across China. Patients aged more than 65 years were selected from the EACH study for this analysis. A novel approach with adjustment for frequency of serum creatinine was used to estimate the incidence of AKI in elderly patients. In-hospital outcomes, including mortality, renal recovery, length of stay and daily cost of elderly patients, were analyzed and compared with outcomes in younger patients. Results: Of 144,232 adult patients in the EACH study, 42,737 (29.63 %) patients were 65 years or older, including 9773 very elderly patients (>= 80 years old). The incidence of AKI was 15.44 % in patients 65-79 years old (community-acquired (CA) AKI of 3.89 % and hospital-acquired (HA) AKI of 11.55 %) and 22.22 % in the very elderly group (CA-AKI of 6.58 % and HA-AKI of 15.64 %). The mortality rate of AKI was 10.3 % in patients aged from 65 to 80 and 19.6 % in patients older than 80 years. AKI incidence, in-hospital mortality, percentage of patients requiring dialysis and percentage without renal recovery were higher in elderly patients than in younger patients. Conclusion: The incidence of AKI in elderly Chinese hospitalized patients is high, which becomes a substantial burden on medical care in China.