Living With One Kidney: Life Insurance Underwriting Impact

Life insurance underwriting is a critical step in the application process, where insurers assess an applicant's eligibility for coverage. This process involves gathering and evaluating relevant details about an individual's health, lifestyle, and financial circumstances to determine their risk class and insurance rates. When it comes to individuals with one kidney, several factors come into play during the underwriting process. Firstly, the reason for the kidney removal, such as kidney disease or kidney donation, will be considered. The presence of any underlying health conditions, such as high blood pressure or diabetes, will also be taken into account. The functionality of the remaining kidney and the overall health of the individual will be assessed, including their age, weight, and lifestyle choices. These factors collectively contribute to determining the eligibility and premium rates for life insurance.

Kidney function test results

Kidney function tests are used to evaluate how well your kidneys are working. They are a primary factor that insurance companies consider when underwriting a policy for someone with kidney disease. The results can indicate whether your kidneys are functioning typically or not, and they can significantly influence your eligibility and premium rates for insurance.

There are several types of kidney function tests, including blood tests and 24-hour urine tests. Blood tests for kidney function include:

• Blood urea nitrogen (BUN) tests, which measure nitrogen (made from protein breakdown) in your blood.
• Estimated glomerular filtration rate (eGFR) tests, which calculate filtration rates based on your protein levels, age, gender, size, and race.
• Serum creatinine tests, which look for the buildup of creatinine, a waste product from muscle tissue breakdown.

For a 24-hour urine test, you will be given a container to collect your urine over a 24-hour period. Urine tests include:

• Microalbuminuria tests, which look for a specific protein called albumin.
• Urinalysis, which evaluates your urine for blood, proteins, and function.

The results of kidney function tests can indicate whether you have kidney disease. For example, a GFR of less than 60 could indicate kidney disease, and a urine albumin-to-creatinine ratio (UACR) of more than 30 milligrams per gram could be a warning sign of kidney disease. If your test results show early kidney disease, your healthcare provider will discuss treatment options and may refer you to a nephrologist. Regular testing will also be recommended to monitor your kidney function and any underlying conditions.

Underlying causes of kidney disease

Kidney disease is a serious condition that can lead to life-threatening complications if left untreated. The kidneys play a crucial role in maintaining overall health by filtering waste and extra fluid from the blood, regulating blood pressure, producing red blood cells, and maintaining bone health. When kidney function is impaired, waste products and fluids can build up in the body, leading to adverse symptoms and potentially life-threatening consequences.

Diabetes and high blood pressure are the most common causes of chronic kidney disease. Over time, high blood sugar levels associated with diabetes can damage the kidneys, along with other organs in the body. Similarly, high blood pressure can create wear and tear on the blood vessels, including those that supply the kidneys, impairing their function.

Another cause of kidney disease is polycystic kidney disease (PKD), a genetic disorder characterised by the growth of numerous cysts in the kidneys. These cysts reduce the kidneys' ability to filter waste from the blood effectively. PKD is inherited from one of the parents and often leads to kidney function impairment.

Lupus, an autoimmune disease, can also cause kidney disease, known as lupus nephritis or lupus nephropathy. In this condition, the body's immune system attacks its own healthy cells, including the kidneys, leading to organ damage.

Glomerular diseases, such as glomerulonephritis or glomerular disease, affect the tiny filters in the kidneys that remove waste from the blood. When these filters are damaged, protein (albumin) leaks from the blood into the urine, indicating kidney damage.

Heavy metal poisoning, such as lead poisoning, and rare genetic conditions like Alport syndrome, are also associated with kidney disease. Additionally, certain medications, toxins, and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) can permanently damage the kidneys.

Acute kidney injuries can occur due to traumatic injuries with blood loss, dehydration, severe infections, enlarged prostates, kidney stones, and complications during pregnancy. Autoimmune diseases, where the body attacks its own tissues, can also lead to acute kidney injuries.

It is important to note that kidney disease often progresses slowly and may not exhibit noticeable symptoms in the early stages. However, early detection and management of underlying conditions, such as diabetes and high blood pressure, are crucial in preventing or slowing the progression of kidney disease.

Lifestyle choices

Lifestyle is a key consideration during the underwriting process. Underwriters will look at factors like your hobbies, driving habits, occupation, and tobacco and alcohol usage.

For example, insurers will assess whether you work in a risky occupation, such as firefighting, or a less risky one, like office work. They will also consider whether you engage in risky hobbies, like outdoor rock climbing, or less dangerous pastimes.

If you have had a kidney transplant, underwriters will want to see evidence that your body has accepted the new kidney and maintained a stable condition post-transplant. They will also want to see that you are following a healthy lifestyle, including a balanced diet and regular exercise, and abstaining from habits like excessive alcohol consumption, smoking, or drug use.

If you are a kidney patient, whether you are undergoing dialysis or awaiting a transplant, securing life insurance can be challenging. Most insurers will decline applications from those undergoing dialysis, and those who have received a kidney transplant will usually need to wait at least a year before applying for life insurance.

The underwriting process for kidney transplant patients is typically more complex and in-depth than for standard applicants. It involves a medical examination, a review of medical history, a lifestyle evaluation, a risk assessment, and policy issuance.

The bottom line is that for kidney transplant patients, your current health condition and prognosis for your future health significantly affect your ability to get life insurance. If you can maintain good health for three years after your transplant, you will likely qualify for both term and whole life insurance.

Risk assessment

The risk assessment process for individuals with one kidney will consider several factors to determine their eligibility and premium rates for life insurance. Here are the key components of the risk assessment:

Medical History and Kidney Function

The primary factor influencing life insurance underwriting for individuals with one kidney is their kidney function, which is assessed through a Kidney Function Test (KFT). The test results will indicate the level of kidney function and any evidence of progressive decline. Effective management of underlying conditions, such as high blood pressure or diabetes, can improve the chances of securing life insurance. Regular monitoring and maintaining favourable KFT results can positively impact the application.

Transplant History

For those who have received a kidney transplant, life insurance companies typically require a waiting period of at least one year post-transplant to ensure minimal chances of organ rejection and complications. The source of the donated kidney, whether from a living donor or a cadaver, may also impact the assessment, with some insurers increasing rates for kidneys sourced from cadavers. The success of the transplant, including the body's acceptance of the new kidney, is crucial for a positive risk assessment.

Treatment and Management

The treatment plan and management of kidney disease play a significant role in the risk assessment. For acute kidney disease, underwriters view applications more favourably if the underlying cause is well-managed and the applicant has good physician follow-up. For chronic kidney disease, the stage of the disease and the specific treatment plan are evaluated closely. Applicants undergoing dialysis treatment are generally considered uninsurable by most companies.

Lifestyle Factors

Lifestyle choices, including smoking, drug use, and alcohol consumption, diet, exercise habits, and driving record, are taken into account during the risk assessment. A healthy lifestyle, including abstaining from harmful substances, can positively influence the assessment and potentially lead to lower premium rates.

Overall Health and Prognosis

The overall health condition and prognosis for the future significantly affect the risk assessment. Maintaining good health and managing any pre-existing conditions can increase the chances of obtaining life insurance. The absence of health complications and a positive prognosis may result in more favourable rates.

Policy issuance

If you have passed the underwriting process, the insurance provider will probably offer life insurance coverage. However, the assessment made by underwriters may result in higher premiums or exclusions in your insurance coverage.

The underwriting process for kidney transplant patients will almost certainly be more extensive than usual, and could mean higher premiums. If you are applying for life insurance with a history of kidney transplant, the insurance company will likely ask you several questions to better understand your medical history and current health status.

Some of the information they may request or be interested in includes:

• Date of transplant: The insurance company will want to know when you received your kidney transplant and how long you have been living with the transplant.
• Reason for transplant: They will also ask about the reason for your transplant and any underlying medical conditions that may have led to kidney failure.
• Medications: The insurance company may ask about any medicines you take, including immunosuppressant drugs commonly used after a kidney transplant.
• Follow-up care: They will likely ask about your follow-up care, including how often you see your transplant team and if you have had any recent medical issues related to your transplant.
• Symptoms: The insurance company may ask about any symptoms you experience related to your transplant, such as fever, pain, or signs of rejection.
• Medical history: The insurance company may request your complete medical account, including any other medical conditions you have been diagnosed with and any medications you currently take.
• Lab test results: The insurance company may request lab results related to your kidney transplant, such as kidney function tests, blood tests, or imaging tests like CT scans or ultrasounds.

The insurance company will use this information to evaluate your overall health and determine the level of risk you represent. Depending on the severity of your condition and the results of any medical underwriting, they may offer you a policy at a higher premium or require additional underwriting, such as a medical exam.

Frequently asked questions