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To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal–pelvic CT combining 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE) in patients with renal dysfunction for oncological assessment. We included 45 patients with renal dysfunction (estimated glomerular filtration rate <45 ml per min per 1.73 m2) who underwent reduced-CM abdominal–pelvic CT (360 mgI kg–1, 80-kVp, SAFIRE) for oncological assessment. Another 45 patients without renal dysfunction (estimated glomerular filtration rate >60 ml per lmin per 1.73 m2) who underwent standard oncological abdominal–pelvic CT (600 mgI kg–1, 120-kVp, filtered-back projection) were included as controls. CT attenuation, image noise, and contrast-to-noise ratio (CNR) were compared. Two observers performed subjective image analysis on a 4-point scale. Size-specific dose estimate and renal function 1–3 months after CT were measured. The size-specific dose estimate and iodine load of 80-kVp protocol were 32 and 41%,, respectively, lower than of 120-kVp protocol (p < 0.01). CT attenuation and contrast-to-noise ratio of parenchymal organs and vessels in 80-kVp images were significantly better than those of 120-kVp images (p < 0.05). There were no significant differences in quantitative or qualitative image noise or subjective overall quality (p > 0.05). No significant kidney injury associated with CM administration was observed. 80-kVp abdominal–pelvic CT with SAFIRE yields diagnostic image quality in oncology patients with renal dysfunction under substantially reduced iodine and radiation dose without renal safety concerns. Using 80-kVp and SAFIRE allows for 40% iodine load and 32% radiation dose reduction for abdominal–pelvic CT without compromising image quality and renal function in oncology patients at risk of contrast-induced nephropathy. [ABSTRACT FROM AUTHOR]