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Introduction: Racial/ethnic disparities have been previously reported in renal and hepatic disease care; however, acute kidney injury (AKI) in the setting of cirrhosis (hepatorenal syndrome [HRS]‐AKI) despite its complexity requiring a multidisciplinary approach, remains understudied. Methods: To identify unique associations of clinical and sociodemographic factors with mortality and length of stay (LOS) among patients hospitalised with HRS‐AKI, hierarchical regression analysis was conducted, along with a mediation analysis to estimate how race‐related differences in in‐hospital mortality were influenced by payer type, area household income, and clinical severity. Results: Black patients demonstrated a significantly higher odds of in‐hospital mortality, compared to their white counterparts, adjusting for (1) sex and age, (2) sex, age, payer type, and area household income and (3) sex, age, and clinical severity [OR 1.16–1.20, 95% confidence intervals (CI) > 1]. Higher mortality rates among Black patients were partially mediated by clinical severity and area household income [proportion mediated (PM): 0.1890.190.192 and 0.160.170.18, respectively]. Black patients with HRS‐AKI had longer LOS than White patients. Hispanic patients tended to have lower odds of in‐hospital mortality [OR: 0.770.860.97] despite their lower income and more severe illness. Conclusion: Our nationwide US study demonstrated that, partly due to higher clinical severity and lower household income, Black patients with HRS‐AKI experience higher inpatient mortality, compared to White patients. On the other hand, Hispanics with HRS‐AKI have a survival advantage. More awareness is warranted to address racial disparities in HRS‐AKI outcomes. [ABSTRACT FROM AUTHOR]