Decreasing levels of renal function act as a major adverse prognostic factor after contrast exposure with or without percutaneous coronary intervention. In chronic kidney disease, the most important risk factor for the development of contrast-induced nephropathy (CIN) is an estimated glomerular filtration rate ≤ 60 mL/min/1.73 m². Additional risk factors include diabetes, proteinuria, volume depletion, heart failure, and intraprocedural events. Overall, CIN occurs in approximately 15% of radiocontrast procedures, with < 1% requiring dialysis. CIN is directly related to increases in hospitalization length, cost, and long-term morbidity. For those patients who require dialysis, a 30% in-hospital mortality rate and 80% 2-year mortality rate can be expected. CIN is predictable and presents an opportunity to utilize preventive strategies, given the increasing numbers of patients undergoing contrast procedures worldwide.