Abstract BACKGROUND AND AIMS Peritoneal dialysis (PD) patients are frequently exposed to contrast media through contrast-enhanced computed tomography (CT) and/or coronary angiography, which may be used as diagnostic tools or as part of pretransplant evaluation. However, the risk of contrast nephropathy frequently limits the use of these imaging techniques. The authors aim to evaluate the loss of kidney function after contrasted examination in PD patients. METHOD We performed an observational retrospective study in a population of patients with end-stage kidney disease on PD. All patients included had performed an ionized radiation-imaging exam (CT or coronary angiography), with or without contrast media. In patients who performed more than one of the aforementioned exams, only the first one was considered. Demographic and laboratory data including kidney function and dialysis dose before and after the imaging exams were collected. We divided the population into two groups (no contrast use versus contrast use) and compared them using Mann–Whitney test or Chi square. A survival analysis was performed (time to exam; outcome—loss of renal function; predictor—contrast use). RESULTS A population of 41 patients in PD, 26 in automated PD (63.4%), with a dialysis vintage of 29 (17–38) months were included in this analysis. The median time since starting PD and the exam was 15 (5–20) months, and contrast was used in 21 exams (51.2%). Five patients underwent coronary angiography and 16 were submitted to contrast-enhanced CT. Only two patients performed contrast nephropathy prophylaxis before contrast exposure. In univariate analysis, we found no difference between renal residual function, KT/v and creatinine clearance before and after the imaging exam, irrespective of contrast use. After the diagnostic exam, 19 patients lost residual renal function [median GFR 1 (1–2) mL/min/1.73 m2], and the group of patients who did not use contrast were the most affected ones; however, there was no statistical significance difference between the two groups (P = 0.08). Since we found a significant difference in the time to imaging exam between the two studied groups, we performed a survival analysis, and the use of contrast was associated with preservation of renal function (P = 0.02). A multivariate Cox analysis with age, Charlson index, GFRe pre-exam, diabetes, use of RAASi, beta-blocker, loop diuretic and spironolactone as potential confounders showed that use of contrast was not associated with loss of renal function in PD patients. CONCLUSION Our study showed that contrast nephropathy is not frequent in PD patients and that we can allow contrast media (low or iso-osmolal) as it was not associated with loss of residual renal function.