Background <p>Patients who develop sepsis-associated acute kidney injury (SAKI) in the intensive care unit face a significantly elevated mortality risk. The lactate-to-albumin ratio (LAR) has been utilized as an important marker for the occurrence and development of various diseases. Nevertheless, the association between LAR and SAKI remains inadequately explored. This study seeks to investigate the connection between the LAR and SAKI.</p> Methods <p>Patients identified with SAKI were selected from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. LAR was recorded at the time of admission, with the primary endpoint being the development of AKI within 7&#xa0;days following the sepsis diagnosis. Logistic regression and subgroup analyses were utilized to assess the relationship between LAR and SAKI.</p> Results <p>The final analysis incorporated data from 4,113 patients retrieved from the MIMIC-IV database. Logistic regression analysis revealed that a 1-unit increase in LAR was linked to a 49% rise in the incidence of SAKI (95% confidence interval, 1.27 to 1.76; <i>P</i> &lt; 0.001). These findings were further validated through subgroup analyses, confirming their robustness.</p> Conclusions <p>Higher LAR at admission was independently associated with an increased risk of SAKI.</p>