In a retrospective Veterans Administration (VA) study, Schaefer et al evaluate changes in serum creatinine levels following colonoscopy and conclude that sodium phosphate enema “increases the risk for VA patients having long-term eGFR [estimated glomerular filtration rate] decline.”1(p609) Two bowel preparation groups were evaluated: (1) enema or enema plus polyethylene glycol (PEG) prescribed up to 6 months prior to colonoscopy, and (2) PEG alone. However, the authors offer no evidence that the enema was actually used for the colonoscopy, either alone or in combination with PEG.