Background <p>Contrast-enhanced diagnostic testing is often withheld in critically ill patients with acute kidney injury (AKI) due to safety concerns associated with iodinated contrast media.</p> Purpose <p>The impact of iodinated intravenous contrast agents on the rate of renal recovery is unknown when administered to patients who present to the intensive care unit with severe acute kidney injury.</p> Materials and methods <p>A retrospective cohort study of cases admitted to the intensive care unit with severe acute kidney injury who received a contrast-enhanced CT (CECT), propensity-matched to controls who received an unenhanced CT (UECT). Primary endpoints were the incidence of subjects with progressive AKI that met criteria for contrast-induced nephropathy, the incidence of renal replacement therapy (RRT) initiation, and the rate of renal function recovery over the first 120&#xa0;h of hospitalization.</p> Results <p>The incidence of progressive acute kidney injury was similar between patients who received a CECT and those who received a UECT in both unmatched and propensity-matched patients with eGFR less than 30 mL/min/1.73 m² at the time of imaging. There was no increased utilization of RRT after 24&#xa0;h in those who received a CECT than those who received a UECT. Renal recovery rate was similar between cases and controls, and unaffected by the provision of iodinated contrast.</p> Conclusion <p>The use of low-osmolar intravenous iodinated contrast does not impede the recovery of eGFR in critically ill patients with severe acute kidney injury.</p>