In our review, we reported an increased risk for in-hospital mortality for elective cardiac, vascular, and general surgery and joint arthroplasty in patients with chronic kidney disease and end-stage kidney disease (ESKD).1 We agree with our colleagues2 that a cautious interpretation of relative risk is needed. Patients with ESKD have a high competing risk for mortality (adjusted mortality rate, 134/1,000 patient-years).3,4 It is also important to consider the magnitude of an intervention’s effect.