Background: This study compares the incidence of post-contrast acute kidney injury (PC-AKI) in patients who received a single administration of iodine-based contrast medium (ICM) with that in patients who received a sequential administration of ICM and gadolinium-based contrast agents (GBCA) in a single visit to an emergency department (ED) to determine the risk factors for PC-AKI. Methods: Patients who received one or more contrast media in the ED from 2016 to 2021 were included in this retrospective study. They were divided into the ICM alone and ICM + GBCA groups, and the incidence of PC-AKI was compared between the groups. The risk factors were assessed using a multivariable analysis after propensity score matching (PSM). Results: Overall, 6,318 patients were analyzed, of whom 139 were in the ICM + GBCA group. The incidence of PC-AKI was significantly higher in the ICM + GBCA group than in the ICM alone group (10.9% vs. 27.3%, p < 0.001). In the multivariable analysis, sequential administration was a risk factor for PC-AKI, and single administration was not (adjusted odds ratio [95% confidence interval] in the 1:1, 2:1, and 3:1 PSM cohorts: 2.38 [1.25-4.55], 2.13 [1.26-3.60], and 2.28 [1.39-3.72], respectively). In subgroup analyses of the ICM + GBCA group, osmolality (1. 05 [1.01-1.10]) and estimated glomerular filtration rate (eGFR,) were associated with PC-AKI. Conclusion: Compared with a single administration of ICM alone, sequential administration of ICM and GBCA during a single ED visit might be a risk factor for PC-AKI. Osmolality and eGFR might be associated with PC-AKI after sequential administration.

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