Objective：To analyze risk factors of hospital death in patients with postoperative acute kidney injury（AKI）after total arch replacement and to provide a reference for the treatment of patients during hospitalization. Methods：We retrospectively analyzed 123 patients whom underwent total arch replacement and had postoperative AKI in the Guangzhou Military Hospital from March 2007 to March 2017. Among them，23 patients died during hospitalization and were included in the death group，and the remaining 100 patients were discharged smoothly and were included in the survival group. Preoperative，intraoperative and postoperative data were analyzed. After univariate analysis，the risk factors were analyzed by COX regression analysis. According to the AKI classification，the survival rate was analyzed by Kaplan-Meier curves. Results：The average length of hospital stay was 37.89 days. The COX regression analysis showed that preoperative creatinine（HR value：1.013），diabetes mellitus（HR value：4.291），re-operation for bleeding（HR value：4.412），postoperative hypoxemia（HR value：5.634）were independent risk factors of hospital death in patients with postoperative AKI after total arch replacement，the difference was statistically significant. Kaplan-Meier curve showed that AKI 3 patients had a significant increase in mortality in comparing with AKI 1 patients（P < 0.05）. Conclusion：Preoperative creatinine，diabetes mellitus，re-operation for bleeding，and postoperative hypoxemia are independent risk factors for hospital death in patients with AKI after total arch replacement，and the risk of death is higher in AKI 3 patients.