Heart Disease Could Be Harming Your Kidneys Too: New Guidelines Urge These Tests
Heart disease may not be a problem that stops at the heart. New guidelines from the European Society of Cardiology (ESC), developed with the European Renal Association (ERA), are urging doctors to pay much closer attention to kidney health in people with cardiovascular disease.
The recommendations, published in the European Heart Journal and presented at ESC Congress 2026, are the first ESC guidelines specifically dedicated to managing cardiovascular disease (CVD) alongside chronic kidney disease (CKD). Their message is straightforward: heart and kidney health are closely connected, and identifying kidney problems early could help reduce complications affecting both organs.
How Are The Heart And Kidneys Connected?
The relationship works in both directions. CKD can increase a person's risk of developing cardiovascular disease, while cardiovascular problems can also contribute to worsening kidney function. The two conditions can therefore create a damaging cycle, potentially increasing the risk of cardiovascular events and, in advanced cases, kidney failure requiring dialysis.
The ESC estimates that around 100 million people in Europe are living with CKD. Importantly, CKD is not simply defined by having one abnormal kidney test. It involves abnormalities in kidney structure or function that persist for at least three months and have implications for health. The new guidelines are designed to make sure kidney disease is not missed when someone is being treated for a heart condition.
Two Tests Doctors Want Heart Patients To Have
One of the biggest recommendations is screening for CKD in people with cardiovascular disease using both blood and urine tests. The first is the estimated glomerular filtration rate (eGFR), which is calculated using blood creatinine levels and provides an estimate of how well the kidneys are filtering blood. The second is the urine albumin-to-creatinine ratio (UACR). It looks for albumin, a protein that can leak into urine when the kidneys are damaged.
The ESC recommends these measurements for people with a range of cardiovascular conditions, including hypertension, coronary artery disease, heart failure, peripheral artery disease and stroke. To establish that kidney abnormalities are chronic, rather than temporary, two measurements of eGFR and UACR over at least three months are recommended.
What Happens If Kidney Disease Is Detected?
The guidelines use a framework called “STAMP on CKD” — Screen, Triage, Address CKD Risk, Modify CVD management and Plan health services.
That means screening is only the first step. Doctors are also encouraged to assess a person's risk of kidney failure and cardiovascular complications, identify appropriate treatments early and adjust cardiovascular care when reduced kidney function affects the safety or effectiveness of certain medicines or procedures.
The recommendations highlight several established treatments. RAS inhibitors, which include ACE inhibitors and angiotensin receptor blockers, and SGLT2 inhibitors are recommended for many patients with CKD because they can reduce the risk of kidney disease progression and cardiovascular complications. Statin-based treatment also remains important where appropriate.
For people who have CKD, type 2 diabetes and albuminuria, the guidelines also recommend considering treatments such as the non-steroidal mineralocorticoid receptor antagonist finerenone and GLP-1 receptor agonists such as semaglutide to reduce kidney and cardiovascular risks. These medicines are not appropriate for everyone and should be prescribed according to an individual's condition and medical history.
What Does This Mean For Patients?
The new guidance does not mean that everyone with heart disease has kidney disease. Instead, it highlights why the two organs should not be assessed in isolation. For someone already diagnosed with cardiovascular disease, a routine conversation with their doctor about kidney function could be important. A blood test and urine test may reveal kidney abnormalities that have not yet caused obvious symptoms, allowing doctors to assess risk and decide whether treatment needs to change.
The broader message from the guidelines is that protecting the heart can also mean paying attention to the kidneys, and protecting the kidneys can help protect the heart. Earlier detection, appropriate treatment and closer coordination between cardiologists, kidney specialists and other healthcare professionals could help break the cycle between the two conditions.