The recent letter by Wasser and colleagues [1] provides an incomplete interpretation of its subject. The letter clearly suggests that chromium picolinate was causally related to the renal failure. The authors gave serious consideration only to chromium picolinate as the possible etiologic agent and did not discuss other possibilities distinctly suggested by the facts presented.

The authors dismissively state that "the only other medications [the patient] received were antihypertensive agents." They provide no information about which antihypertensive agents were used, whether changes in medication were made during the period under consideration, or the degree to which the hypertension was controlled.

The terse dismissal of other possible causes of renal failure is perplexing. Were the kidney-damaging effects of several antihypertensive agents, and hypertension itself, considered? An explanation other than chromium picolinate seems most likely given the following factors: absence of other published cases that causally relate oral chromium, in any form, to renal failure (MEDLINE search, 21 March 1997), the possible toxic effects of the unspecified antihypertensive agents, and the kidney-damaging effects of uncontrolled hypertension.

If these large gaps in information are not filled or if other etiologic factors confound the case, this report should not be considered to be evidence of renal toxic effects of chromium picolinate.