Sepsis is a major cause of acute kidney injury (AKI). Sepsis-associated AKI (SA-AKI) requiring continuous kidney replacement therapy (CKRT) is associated with high mortality, and survivors may develop permanent kidney damage. This study investigated the risk of end-stage kidney disease (ESKD) based on kidney function trajectories in survivors of SA-AKI requiring CKRT. From 2011 to 2024, 820 adult patients received CKRT for SA-AKI. After excluding those with preexisting ESKD on dialysis, in-hospital deaths, and missing serum creatinine (SCr) data, 119 patients were included (Figure 1). Acute kidney disease (AKD) was defined at 7 days after CKRT initiation as follows: a ≥35% decrease in estimated glomerular filtration rate, a ≥50% increase in SCr, or the need for kidney replacement therapy. Progression was defined as meeting AKD criteria at 90 days. Patients were classified into four groups: early recovery, late progression without AKD, late recovery after AKD, and early progression (Figure 1). The primary outcome was the development of ESKD among the kidney function trajectory groups. The development of ESKD significantly differed among the groups (Figure 2A). The early recovery group showed the lowest risk (1/47, 2.1%), whereas the early progression group showed the highest (18/29, 62.1%). ESKD developed in 3/6 (50.0%) of the late progression without AKD group and 3/37 (8.1%) of the late recovery after AKD group. In multivariable analysis (Figure 2B), the early progression group (hazard ratio [HR] 77.010, P<0.001) and the late progression without AKD group (HR 22.635, P=0.003) were significant predictors of ESKD, along with preexisting CKD and older age. Lower Glasgow Coma Scale (GCS), hemoglobin, and serum albumin were associated with early progression (Figure 2C). Survivors of SA-AKI requiring CKRT exhibited distinct kidney function trajectories. The early progression group had the highest ESKD risk, associated with lower GCS, hemoglobin, and serum albumin.