ABSTRACT
Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied.
Subject(s)
Insurance, Life , Kidney Transplantation/economics , Living Donors , Canada , Data Collection , Humans , Insurance Carriers , Insurance, Life/economics , Insurance, Life/ethicsABSTRACT
Women considering kidney donation frequently ask whether a nephrectomy will impact their ability to have children. Two new studies consider this issue. We place the new information in the context of previous literature and practice guidelines, and discuss how we should counsel and care for our donors in the year 2009.
Subject(s)
Fertility , Fetal Development/physiology , Living Donors , Nephrectomy/adverse effects , Pregnancy Complications/epidemiology , Pregnancy Outcome , Premature Birth/epidemiology , Europe/epidemiology , Female , Glomerular Filtration Rate , Humans , Hypertension/epidemiology , Incidence , Infant, Low Birth Weight , Infant, Newborn , Pregnancy , United States/epidemiologyABSTRACT
Whether renal dysfunction is an important factor in postoperative risk assessment has been difficult to prove. In an attempt to provide more compelling evidence, we conducted a systematic review comparing the risk of death and cardiac events in patients with and without chronic kidney disease who underwent elective noncardiac surgery. From electronic databases, web search engines, and bibliographies, 31 cohort studies were selected, evaluating postoperative outcomes in patients with chronic kidney disease. These patients had higher risks of postoperative death and cardiovascular events compared to those with preserved renal function. The pooled incidence of postoperative death was significantly less in those with preserved renal function than in those patients with chronic kidney disease. Meta-regression showed a graded relationship between disease severity and postoperative death. In adjusted analysis, chronic kidney disease had a similar strength of association with postoperative death as diabetes, stroke, and coronary disease. Our review identifies chronic kidney disease as an independent risk factor for postoperative death and cardiovascular events after elective, noncardiac surgery.
