In Reply Drs Niemi and Mandelbrot express concerns that some of our NHANES exclusion criteria might be too stringent, rendering the healthy nondonor comparison group healthier than donors and less likely to develop ESRD. Although we agree that a history of mild asthma or remotely treated thyroid malignancy would not preclude donation, it also seems unlikely that these diseases would cause ESRD.
Dr Matas and colleagues express concern that donors have more factors associated with increased risk of ESRD such as significantly higher systolic blood pressure and body mass index; however, we are skeptical that clinicians would consider systolic blood pressure of 1.8 mm Hg or body mass index of 0.5 to be significantly higher. Regardless, we have previously shown that the same healthy nondonors are not healthier: they have a higher mortality than donors,1 and it is unlikely that attributes causing higher mortality also cause lower ESRD risk.
Muzaale AD, Massie AB, Segev DL. Kidney Donation and Risk of ESRD—Reply. JAMA. 2014;312(1):93-94. doi:10.1001/jama.2014.5524