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We explored the incidence, risk factors, and clinical characteristics of acute kidney injury (AKI) within 100 days posttransplantation, and its impact on the prognosis of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in elderly patients. A total of 224 elderly patients diagnosed with acute leukemia received haplo-HSCT between January 1, 2019, and December 31, 2023 at Peking University People's Hospital. AKI affected 54.9% of the patients, with 33.5% in Stage 1, 18.3% in Stage 2, and 3.1% in Stage 3. Being female and having hypoalbuminemia were independent risk factors for developing severe AKI. Three-year overall survival for AKI Stages 0, 1, 2, and 3 were 73.4%, 75.9%, 56.6%, and 14.3%, respectively (p = 0.000). The 3-year event-free survival rates were 70.7%, 73.0%, 46.2%, and 0% (p < 0.001). The 3-year transplantation-related mortality was 13.8% for Stages 0-1 and 48.1% for Stages 2-3 (p < 0.001). Our study showed that more than half of elderly patients who underwent haplo-HSCT developed AKI. Being female and having hypoalbuminemia before transplantation were at a significantly higher risk for severe AKI. Experiencing Stage 2 or more severe AKI was found to be an independent risk factor for increased mortality.