Purpose: There is a well-established link between acute kidney injury (AKI) and pediatric cardiac surgery, but few studies evaluating AKI after the Hybrid palliation for hypoplastic left heart syndrome (HLHS). One small study reported an AKI incidence of 29% in the hybrid population, but a majority of centers utilize the Hybrid palliation predominantly for high risk patients. Few centers utilize the Hybrid palliation as a primary palliative strategy, and thus we hypothesized that our population of HLHS patients, who underwent the hybrid procedure as a primary option, would have a lower incidence of AKI than previous publications. We also hypothesized that patients with AKI would have an increased incidence of mortality. Methods: Single center, retrospective review of patients with HLHS anatomy who underwent Hybrid palliation from 2008-2018. Demographics, mortality information, and laboratory data through post-operative day 3 were obtained through chart review. AKI was defined as a dichotomous yes (Stage 1, Stage 2, or Stage 3) or no (no injury) utilizing two different criteria; Acute Kidney Injury Network (AKIN) and Kidney Diseases Improving Global Outcomes (KDIGO). The primary outcomes were incidence of AKI, 30-day mortality, and survival to the comprehensive stage two procedure without conversion to Norwood stage 1 or transplantation. Data are presented as a median (Quartile 1, Quartile 3) or N (%). All comparisons utilized a p value of 0.05 for significance. Results: We identified 83 patients with a median age at palliation of 6 days (4,8), gestational age 39 weeks (38, 39), birth weight 3.17 kg (2.9, 3.56), weight at Hybrid palliation 3.26 kg (2.92, 3.65). HLHS anatomic variants were: Mitral Atresia (MA)/Aortic Atresia (AA) 36 (42%), Mitral Stenosis (MS)/AA 22 (26%), MS/Aortic Stenosis (AS) 27 (32%). Patients with a prenatal diagnosis of HLHS were less likely to develop AKI (6/64 patients (9.4%) vs. 5/21 patients (23.8%), p=0.013). The incidence of AKI was 11/83 (13.3%); (None 72 (86.8%); Stage 1, 9 (10.8%); Stage 2, 2 (2.4%); Stage 3, 0 (0%). Overall mortality was 20/83 (24.1%) and the inter-stage mortality was 12/83 (14.4%). There was no significant difference in mortality prior to comp II ((4/11 patients (36.4%) vs. 16/72 (22.2%), p=0.45) or 30 day mortality ((3/11(27.3%) vs. 5/72 (6.9%), p=0.68) when comparing Hybrid patients with AKI to Hybrid patients without AKI. Conclusions: Utilization of primary Hybrid palliation in HLHS patients may be associated with a lower incidence of AKI (defined by AKIN/KDIGO) than previously reported (13.3% compared to 29%). Our severe rate (Stage 2+3) of AKI was only 2.4%. There was a non-significant trend in 30 day mortality in Hybrid patients with AKI. The presence of AKI following Hybrid palliation was not associated with survival to the comprehensive stage two.