Acute kidney injury, characterized by a sudden decline in glomerular filtration rate, presents a significant global health challenge, with its high prevalence exacerbated by hypertension and limited healthcare access. This systematic review and meta-analysis examined 19 studies encompassing 11,955 participants to assess acute kidney injury prevalence and associated factors in hospitalized patients in Ethiopia. The overall pooled prevalence of acute kidney injury was found to be 3.20% (95% CI 2.91–3.48), with considerable heterogeneity (I2 = 99.3%; p < 0.001). Subgroup analyses identified elevated rates of acute kidney injury in studies conducted post-2020 (31.656%, 95% CI 24.465–38.848), particularly in the Oromia region (41.622%, 95% CI 11.873–71.372), and smaller study sample (< 400) (44.524%, 95% CI 30.117–58.932). Hypertension, congestive heart failure, sepsis, chronic kidney diseases, and nephrotoxicity emerged as significant risk factors. Regular monitoring of renal function through blood and urine analyses is crucial for early detection and management of acute kidney injury, particularly in high-risk groups. Addressing healthcare disparities and reducing nephrotoxic medication use are essential strategies to mitigate acute kidney injury incidence and improve kidney health outcomes worldwide.