Kidney disease and life insurance

Assessed on numbers, not on a label

Kidney underwriting is unusually quantitative. Two measurements do most of the work, and both are in your bloodwork and urine tests.

eGFR, the estimated glomerular filtration rate, indicates how well the kidneys are filtering. It is the primary measure of function, and it is what stages of chronic kidney disease are based on.

Protein in the urine, often reported as an albumin to creatinine ratio, indicates kidney damage independently of filtration rate. It is an important marker, and it can be significant even where eGFR looks reasonable.

Underwriters read both, and they read the trend across whatever results exist. Stable numbers over several years are assessed very differently from the same numbers arrived at through steady decline, because the trend indicates where things are heading.

If you know roughly what your recent eGFR has been, that tells you more about what to expect than the stage number does.

The cause matters

Underwriters ask what caused it, because the answer shapes the outlook and because the cause is usually still present.

Diabetes is a leading cause in Canada. Where kidney disease is diabetic in origin, it is assessed as part of the diabetes picture rather than separately, and it makes that assessment considerably more serious. See life insurance with diabetes.

High blood pressure is the other leading cause, and the same applies. See high blood pressure.

Polycystic kidney disease is inherited and progressive, and underwriters assess it on current function and family history together.

A single past injury, such as kidney damage from an infection or a medication that has since resolved, with function returned to normal, is a much smaller matter than progressive disease.

Where the cause was never identified, underwriters have less to work with and assess cautiously.

Realistic outcomes by stage

Early chronic kidney disease with mildly reduced eGFR, little or no protein in the urine, stable readings and a treated underlying cause is often insurable, sometimes at standard rates and more often with a modest rating.

Moderate reduction in function attracts more substantial ratings, and the presence of significant proteinuria pushes the assessment further.

Advanced disease approaching the need for renal replacement therapy is where fully underwritten offers become uncommon.

Dialysis generally places fully underwritten coverage out of reach at most insurers. What remains is guaranteed issue, which asks nothing about health, at a smaller amount and with a waiting period at the start, and sometimes simplified issue depending on the specific questions asked. Coverage of some kind is normally still obtainable.

Transplant

A kidney transplant is assessed on what happened afterwards rather than on the fact of it.

Underwriters look at how long ago the transplant was, how the graft is functioning now measured by the same eGFR and protein tests, whether there have been rejection episodes, what immunosuppression is required, and whether there have been complications or infections.

Most insurers want a defined period after transplant before assessing, since the early period carries the highest risk of complications. Applying too soon results in a postponement.

A transplant several years in the past with good stable graft function and no rejection episodes can be assessed considerably more favourably than the dialysis it replaced.

What it appears with

Kidney disease rarely stands alone, and the accompanying conditions frequently drive the outcome as much as the kidney function does.

Diabetes and high blood pressure are the usual companions and are assessed together with it rather than separately. Cardiovascular disease is common alongside reduced kidney function and adds to the picture. Anaemia and bone metabolism changes may appear in the records at more advanced stages.

An underwriter reads all of it as one file.

Applying

Have your recent eGFR and urine protein results, when the disease was identified, what caused it, what medication you take, whether you see a nephrologist, and how the numbers have moved over the last few years.

If you are on dialysis or have had a transplant, be specific about dates and current status.

Apply fully underwritten first unless dialysis makes that clearly futile. Insurers differ in the mild to moderate range, and the trend in your results can matter more at one company than another.

The boundary

This page describes how insurance applications are assessed. It is not information about kidney disease, its treatment or its monitoring, and nothing here is a target or a recommendation. That belongs with your nephrologist or family doctor.