Objectives: Microcirculatory dysfunction plays a critical role in the development of sepsis-associated acute kidney injury (S-AKI), however, whether it influences renal recovery remains uncertain. We investigated the association of microcirculatory function assessed using contrast-enhanced ultrasound (CEUS) with renal outcomes in patients with S-AKI receiving renal replacement therapy (RRT). Methods: This study included 23 patients who underwent RRT due to S-AKI, and they were compared with 17 healthy individuals and 18 subjects with chronic kidney disease (CKD). Renal recovery was defined as RRT independence within 90 days after RRT initiation. Results: Of the CEUS-derived parameters, patients with S-AKI had longer duration of rise time, time to peak, and fall time than healthy individuals did (P=0.039, 0.045, and 0.072), but peak enhancement, wash-in/out area under the curve (AUC), and wash-in perfusion index were similar. Parameters did not differ between the S-AKI and CKD groups. Renal recovery occurred in 13 (56.5%), thus, remaining 10 (43.5%) required the lifelong dialysis treatment. Patients without recovery had lower values of peak enhancement, wash-in/out AUC, and wash-in perfusion index (P=0.049, 0.021, 0.036, and 0.049). In addition, despite the statistical insignificance, the associations were observed after the adjustment with age, sex, and disease severity (P=0.096, 0.065, 0.094, and 0.072, respectively). We further evaluated the receiver operating characteristic curve and observed that CEUS-derived peak enhancement, wash-in/out AUC, and wash-in perfusion index predicted renal recovery (P=0.047, 0.022, 0.035, and 0.047). Conclusions: CEUS may help to predict the probability of renal recovery in patients with S-AKI receiving renal replacement therapy, by estimating microcirculatory function. Further studies are necessary to verify the utility of CEUS, considering baseline renal function and pathologic findings.