OBJECTIVE: To explore the prognostic value of the Acute Kidney Injury Network (AKIN) criteria in patients with acute paraquat (PQ) poisoning. METHODS: A retrospective study on 184 patients with acute PQ poisoning admitted to the Shandong Provincial Hospital from April 2010 to March 2013 was done. The clinical data and AKIN stage were compared between survivors and non-survivors, and multivariate analysis was done by Cox-proportional hazards regression model. Kaplan-Meier method was used to analyze survival rate of the patients in different stages of poisoning. RESULTS: The 60-day mortality was 42.93% (79/184). There were no significant differences between the survival and non-survival groups in respect of gender, simultaneous alcohol drinking, duration between ingestion and gastric lavage, duration between ingestion and first hemoperfusion, and number of hemoperfusion. Significant differences were found between two groups in age, quantity of ingestion, receiving hemoperfusion or not, AKIN stage, and initial laboratory data including white blood cell count, the percentage of neutrophil, blood glucose, blood urea nitrogen, creatinine, ß2-microglobulin (ß2-MG), serum K+, CO2, anion gap, and urinary concentration of PQ. The AKIN stage [odds ratio (OR)=3.242, 95% confidence interval (95%CI) 2.236-4.701, P=0.000], urinary concentrations of PQ (OR=1.773, 95%CI 1.008-3.116, P=0.047), the amount of ingestion (OR=1.003, 95%CI 1.000-1.006, P=0.040), and CO2 (OR=0.094, 95%CI 0.891-0.991, P=0.021) were independent prognostic factors for death among them. Kaplan-Meier survival analysis showed the survival rate of AKIN 3 group was significantly lower than that in AKIN 2 group (5.88% vs. 56.25%, χ2=16.149, P=0.000), AKIN 1 group (5.88% vs. 78.95%, χ2=62.444, P=0.000) and non-AKI group(5.88% vs. 100.0%, χ2=173.549, P=0.000). CONCLUSIONS: The AKIN staging is a reliable marker for mortality prediction in acute PQ poisoning patients. In cases without facilities to determine plasma PQ concentration, the staging of AKIN may be a simple and practical tool for assessing the severity of PQ poisoning.