IGF1 and chronic kidney disease: Other potential mitigating factors include the fact that the average live kidney donor is 40 years of age when IGF-1 levels are not at their highest and fall over time, an absence of an alloimmune milieu, lower GH levels in live donors (versus CKD and ESKD which are high-GH states) (70–72), and the presence of innervation that may protect against hyperfiltration.