Abstract Background and Aims Acute kidney injury (AKI) occurs in 15-60% of intensive care unit (ICU) admissions and is associated with higher mortality, morbidity and increased healthcare costs. Major adverse kidney events (MAKE) is a clinically meaningful patient-centred outcome for AKI which includes mortality, need for renal replacement (RRT) and persistent kidney dysfunction. There is a paucity of data on the incidence and risk factors of MAKE, particularly from developing countries. We sought to examine the incidence of MAKE at day 30 (MAKE30) and its predictors in a cohort of critically ill patients with sepsis. Method This was a prospective cohort study conducted in the medical ICUs of a tertiary-care hospital in India. Ethical clearance was obtained from the Institutional Ethics Committee. Adult patients (≥ 18 years) admitted in the medical ICUs between 1st September, 2022 and 31st December, 2022 with sepsis (as defined by Sepsis-3 criteria) were included. Those with chronic kidney disease stage 5/5D, those requiring dialysis within 72 hours of admission and with an ICU stay of <72 hours were excluded. Baseline clinical and demographic data were recorded on the day of admission. AKI was defined as per KDIGO 2012 guidelines. Patients were followed up till hospital discharge or day 30 (whichever was earlier) and clinical outcomes were noted. The primary outcome measure was MAKE30 (defined as a composite of death, provision of RRT, or sustained loss of kidney function i.e., a final inpatient creatinine ≥200% of the baseline value, at hospital discharge or at 30 days, whichever comes first). Results A total of 250 patients admitted in the medical ICUs during the study period were included for analysis. The baseline characteristics are tabulated below (Table 1). Over the 30-day follow-up period, AKI was noted in 185 (74%) patients, with stage 1 AKI in 38 (15.2%), stage 2 AKI in 29 (11.6%) and stage 3 AKI in 118 (47.2%). Renal replacement therapy was initiated in 86 (34.4%) patients. Mortality occurred in 58 (23.2%). Overall, MAKE30 was seen in 102 (40.8%) patients. Serum lactate (OR 1.04, 95% CI:1.01-1.06; P = 0.010) and SOFA score (OR 1.38, 95% CI:1.27-1.56; P <0.001) at admission were independently associated with MAKE30 (Table 2). There was no association with age, gender, diabetes, type of resuscitation fluid or cumulative fluid balance (at 72 hours) with MAKE30. Conclusion In this cohort of critically ill patients with sepsis, MAKE30 was observed in 40.8%. Serum lactate and SOFA score at admission were independent predictors of MAKE30.