—We are in basic agreement with the letter of Levitz and Friedman. Our article has shown a low incidence of contrast-induced acute renal failure in diabetics both with and without preexisting renal insufficiency. However, six diabetics in whom renal insufficiency was detected had only a mild elevation in their serum creatinine levels (average level, 1.6 mg/dL). As pointed out in our discussion, this may account for the differences between our results and those reported by Harkonen and Kjellstrand.1 In a similar manner, the patient here had a serum creatinine level of 3.8 mg/dL before the contrast study, a level of renal function well below those of the group of diabetics with renal insufficiency described by us.
We also agree that measures to ensure volume repletion and a high urine flow, eg, sodium chloride irrigation or mannitol therapy, may not prevent contrast media—induced renal failure. This is highlighted by
Cohen AJ, Pletka PG. Failure of Protective Measures to Prevent Contrast Media—Induced Renal Failure-Reply. Arch Intern Med. 1982;142(3):643. doi:10.1001/archinte.1982.00340160223040