In this large retrospective study, the administration of GBCAs was not associated with higher rates of AKI, which remained consistent across varying levels of baseline renal function. Furthermore, no significant increase in GBCA-associated acute ADRs was observed in patients with impaired renal function. These findings suggest that GBCA administration is generally well-tolerated across a wide spectrum of renal function, without increasing the risk of AKI or GBCA-associated acute ADRs.