New data suggest that severe reductions in estimated glomerular filtration rate (eGFR) and the development of end-stage renal disease (ESRD) after kidney donation are not common among white donors. After a mean follow-up of 16.6 years, 215 of 3,956 donors (6.1%) had proteinuria and 112 donors (2.8%) had either an eGFR <30 ml/min/1.73 m2 or ESRD. Individuals who developed postdonation diabetes and hypertension had a fourfold higher risk of proteinuria and a greater than twofold higher risk of ESRD than those who did not develop these comorbidities.