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To the Editor: Grams et al. (Feb. 4 issue)1 quantified the associations between “13 distinct demographic and health characteristics” and end-stage renal disease among low-risk members of seven general population cohorts in order to estimate the long-term risk of end-stage renal disease among kidney-donor candidates. Two important factors were not considered: biologic and household relatedness to a person with end-stage renal disease. Most living kidney donors are genetically related to their recipients, and heredity is a known contributor to kidney disease.2 Furthermore, many related donors and their recipients grow up following similar dietary, exercise, and other health-related practices, factors that also affect the incidence of end-stage renal disease.3-5 Grams et al. acknowledge the importance of genetic and environmental influences when they note that these influences may have contributed to the variation in risk associated with race uncovered in their study. The failure to incorporate these two factors into their equations renders the authors’ estimates of the risk of end-stage renal disease suspect at best.

Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate