As the United States population ages, and those over age 80 make up a larger aggregate of life insurance applicants, insurers are keeping a watchful eye on risks that develop frequently within this age group. One risk commonly seen is renal or kidney failure.
Life insurance agents and advisors who work with this age group should therefore become familiar with the basics of the disease and the related underwriting considerations. First, here are the basics, as based on common underwriting understandings drawn from the medical literature:
Renal failure relates to damage involving kidney tissue becoming either permanently or temporarily incapacitated. It leads to total or decreased loss of the kidneys’ normal ability to remove waste from the body.
Renal failure is generally categorized and diagnosed as either “chronic” or “acute.” Diagnosing either type may take time, numerous physician follow-up visits and testing. Here are some generalities:
“Acute renal failure” has a sudden onset and in most cases can be reversed. Generally speaking, its symptoms largely depend on the underlying cause. Some causes may include a recent infection, hemorrhage, abdominal pain (including a detectable abdominal mass), little or no urine output, fever and possible recent trauma, among others.
“Chronic renal failure,” on the other hand, progresses slowly. It destroys the kidney tissue, often leading to permanent renal failure. Chronic renal failure may result in urinary incontinence, frequent urinary tract infections, bone pain, headaches, swelling of tissues, causing pain and irritability.
In associating renal failure with age of the life insurance applicant, there are several kidney function test (KFT) results to consider. Any of the following are good indicators for assessing renal risk.
BUN. The blood urea nitrogen (BUN) tends to increase when kidney tissue has been damaged. BUN with an elevation greater than 25 milligrams may indicate some renal impairment. Generally, a BUN greater than 35 milligrams would indicate a more severe stage of the disease.
Creatinine clearance test. This entails collecting a 24-hour urine specimen and then taking a blood draw. Creatinine is a chemical waste that the kidneys filter out of the body via urine. The test determines the creatinine that might have been absorbed back into the blood rather than being filtered out as waste.
GFR. The creatinine clearance test results help determine the glomerular filtration rate (GFR), a standard used to measure kidney function. As people age, the GFR decreases and evaluations should be adjusted accordingly. For those over age 70, a GFR of 75mL (milliliter) is generally acceptable and would be considered stable.
Renal biopsy. A renal biopsy, or an intravenous phyleogram (IVP), is an X-ray that measures the distribution of injected dye in the kidneys via images taken at various time intervals. If the test shows unequal amounts of dye in the kidneys, that would be a good indicator of a renal condition being present.
As with all life insurance risk evaluations, the evidence of other maladies can complicate the determination of assessing the applicant.
Chronic diseases such as diabetes and hypertension are leading factors relating to the damage they can cause to the kidneys. Good physician follow-up in keeping blood sugars under control and blood pressure within normal limits are a measure in determining kidney failure. If kidney failure is present and these issues are not treated aggressively, deterioration will result and continue to progress resulting in complete renal failure.
When an applicant has renal history or risk factors, remember first to review any kidney function tests.
Keep in mind a slight elevation in a creatinine level does not always indicate renal disease is present. There are many medications that may elevate creatinine, including regular aspirin. Individuals who have a history of weight lifting or who have a muscular build tend to secrete higher levels of creatinine, too.
As well, elevations in BUN, although not as specific as creatinine, can be an indicator of other events. For instance, increased BUN is seen in those who have bleeding ulcers or who may have diets high in protein.
So, although both these tests are good indicators for assessing the risk, be sure to review all the evidence before introducing the case.
Chronic renal failure cases are somewhat difficult to assess and should initially be reviewed by gathering evidence to present to the insurance company underwriting department. Information such as treatment for any known causes, blood pressure histories, current and past lab results showing the GFR, and any recorded complications will need to be included. Evidence showing the disease has been caught early may result in a positive prognosis.
To be considered an insurable life insurance risk for acute renal failure, the applicant should be able to show good physician follow-up.
Diabetes, hypertension, vascular problems and cardiac conditions that are not controlled are major factors which have an adverse effect on the prognosis and outcome of acute renal failure. If these issues are not maintained and controlled, it would be difficult to present this type of risk for a favorable underwriting determination. However, cases showing a good treatment regime and control of the underlying complications will slow the progression of permanent kidney damage.
In conclusion, be aware that carefully selected cases can be acceptable for life underwriting. A standard rating is not always likely; however, it’s not impossible for those having acute renal failure.
Good communication between advisor and applicant is the key to helping organize the case effectively. Be sure to ask the proper questions to obtain the pertinent information which will aid in adequately presenting the case in an organized format for the best possible underwriting consideration.