The aim of this large population-based cohort study was to determine whether pyogenic liver abscess (PLA) is associated with the risk of acute kidney injury (AKI).A total of 31,815 patients aged 20 years or older diagnosed with PLA for the first time during hospitalization between 2000 and 2011 were included in a PLA cohort, and 127,620 age- and sex-matched patients without PLA were included in a non-PLA cohort. The incidence and the risk of the first attack of AKI at the end of 2011 were measured. Cox proportional hazard regression models were used to analyze the risk of AKI.In mean follow-up periods of 4.36 and 4.94 years for the PLA and non-PLA cohorts, respectively, the overall incidence of AKI was 1.51-fold greater in the PLA cohort than in the non-PLA cohort (9.25 vs 6.11 events per 1000 person-years; 95% confidence intervals [CIs] = 1.42-1.61). After we controlled for potential confounding factors, the adjusted hazard ratio (aHR) of AKI was 1.36 (95% CIs = 1.27-1.46) for the PLA cohort compared with the non-PLA cohort. Moreover, among patients without comorbidities, the risk of AKI remained higher in the PLA cohort compared with the non-PLA cohort (aHR: 1.91, 95% CIs = 1.59-2.29).This study suggests that PLA associates with an increased risk of AKI. Clinicians should be aware of the potential risk of AKI after diagnosis of PLA.