To the Editor:

Thank you for allowing me this opportunity to contribute my comments to the recent article by Dr. Barreto (2007) regarding strategies for prevention of the acute kidney injury induced by iodinated contrast media. The evidence for the use of iso-osmolar contrast in high-risk patients is a single 129-patient study published in 2003 (Aspelin et al., 2003). However, several other larger and more recent studies have failed to find iso-osmolar contrast superior to low-osmolar contrast in patients with renal insufficiency (CKD).

In 2005, Brigouri and colleagues reported that contrast-induced nephropathy (CIN) rates were not significantly different when patients ...