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Diagnostic and interventional radiographic procedures in critically ill patients commonly depend on iodinated contrast media and consequently pose the risk of contrast-induced acute kidney injury. This is an important complication that accounts for a significant number of cases of hospital-acquired renal failure, with adverse effects on prognosis and healthcare costs. The epidemiology and pathogenesis of contrast-induced acute kidney injury, baseline renal function measurement, risk assessment, identification of high-risk patients, contrast medium use, and preventive strategies will be discussed in this article. An algorithm is suggested for the risk stratification and management of contrast-induced acute kidney injury as it relates to patients undergoing iodinated contrast exposure during critical illness. Contrast-induced acute kidney injury is likely to remain a significant challenge for intensivists in the future because the patient population is aging and chronic kidney disease and diabetes are becoming more common.