Every patient newly diagnosed with cardiovascular disease should be screened for chronic kidney disease using a blood test and a urine test, according to the first European Society of Cardiology guidelines devoted to the two conditions together.
The recommendation matters because the two conditions feed each other. Kidney disease accelerates heart disease, heart disease accelerates kidney disease, and each one worsens the outlook for the other. Yet the two have historically been managed by separate specialists working from separate documents.
One caution belongs at the top for American readers. These guidelines were developed by the European Society of Cardiology with the European Renal Association. They do not automatically change what a cardiologist in Dallas or Cleveland does tomorrow, and U.S. professional societies write their own guidance.
Two Cheap Tests That Are Often Skipped
The screening the guidelines call for is neither novel nor expensive. It combines an estimated glomerular filtration rate, calculated from a blood creatinine measurement, with a urine albumin-to-creatinine ratio.
The blood test is routine and frequently already on file. The urine test is the one that often gets missed, and it is the one that detects kidney damage earliest, because small amounts of the protein albumin start leaking into urine before filtration measurably declines.
That sequencing is the reason the guidelines insist on both. Running only the blood test can produce a normal-looking result in someone whose kidneys are already being damaged. According to the European Society of Cardiology press release, screening every cardiovascular patient at diagnosis is the first step in the framework.
The task force built its recommendations around an acronym it calls STAMP on CKD, standing for screen, triage, address chronic kidney disease risk, modify cardiovascular management, and plan health services. Triage means assessing both the risk of kidney failure and cardiovascular risk using validated scoring systems that account for kidney function.
The Scale of the Overlap
Chronic kidney disease is defined as abnormalities of kidney structure or function lasting at least three months with implications for health. The guidelines estimate around 100 million people in Europe have it, all of them at increased risk of a wide range of cardiovascular diseases as a result.
The document was co-chaired by Associate Professor Kevin Damman of University Medical Centre Groningen in the Netherlands and Professor William Herrington of the University of Oxford. Damman said kidney disease can accelerate cardiovascular disease and the reverse is also true, pushing cardiovascular events and the need for dialysis much earlier in life.
The guidelines were published in the European Heart Journal in late August and presented at the society's annual congress in Munich the following day. A patient version of the guidelines was released alongside the clinical document.
Treatments That Already Exist and Are Underused
The guidelines are not waiting on new drugs. Their emphasis falls on medicines already sitting in pharmacies.
Damman said early use of RAS inhibitors and SGLT2 inhibitors alongside statin-based therapy is "particularly important and effective." RAS inhibitors are the ACE inhibitors and angiotensin receptor blockers used for decades in blood pressure and heart failure. SGLT2 inhibitors were developed for type 2 diabetes and have since been shown to protect kidneys and hearts in people without diabetes.
The document also addresses where cardiac care itself needs adjusting. It includes recommendations on which medications are appropriate for patients whose reduced kidney function limits their ability to clear standard treatments from the body. Herrington, the other task force chair, emphasized that many patients with kidney disease are already being treated by cardiologists, which is why the screening push is aimed at that specialty rather than at nephrology alone.
The Practical Change for an American Patient This Year
The honest answer is not much yet, and expecting otherwise would misread how guidelines work.
That said, a patient with heart disease can reasonably ask a cardiologist or primary care physician whether a urine albumin-to-creatinine ratio has ever been done. Many people with cardiovascular disease have had creatinine checked dozens of times and the urine test never. Asking costs nothing.
The test is inexpensive and generally covered by commercial insurance and Medicare when medically indicated, particularly for patients with diabetes or high blood pressure, where kidney screening is already standard in U.S. practice. People without insurance can ask about federally qualified health centers, which charge on a sliding scale.
Nobody should start, stop, or change a medication based on a guideline written for another health system. SGLT2 inhibitors in particular carry real considerations around cost, urinary and genital infections, and a rare risk of ketoacidosis, and they are not appropriate for everyone.
Several things remain unsettled. The guidelines reflect expert consensus on existing evidence rather than a new trial, and universal screening at diagnosis has not been tested in a randomized study measuring whether it improves outcomes. Whether U.S. societies adopt a comparable recommendation, and how quickly, is unknown. Implementation across systems where cardiology and nephrology bill and operate separately is its own obstacle, which is why the final step in the framework concerns planning health services rather than clinical care.
There is also a capacity question. Screening every cardiovascular patient would identify a large number of people with early kidney disease who then need follow-up, monitoring, and in some cases a nephrology referral. Whether health systems can absorb that volume, and whether identifying mild cases changes outcomes for those patients, are the practical tests any screening recommendation eventually faces. The full guideline document sets out the evidence gaps the authors want research to fill.
Key Questions Answered
What do the new guidelines recommend? Screening every patient with cardiovascular disease at diagnosis for chronic kidney disease using estimated glomerular filtration rate from blood creatinine plus a urine albumin-to-creatinine ratio.
Who wrote them? The European Society of Cardiology in collaboration with the European Renal Association. They are the first ESC guidelines dedicated to cardiovascular disease and chronic kidney disease together.
Do these apply in the United States? Not automatically. U.S. professional societies issue their own guidance, and American practice is not bound by European guidelines.
Why does the urine test matter if blood work is normal? Albumin can appear in urine before kidney filtration measurably declines, so a urine test can detect damage that a blood test alone would miss.
Which treatments do the guidelines emphasize? Early use of RAS inhibitors and SGLT2 inhibitors alongside statin-based therapy, all of which are already available.
What can a patient do now? Ask a cardiologist or primary care physician whether a urine albumin-to-creatinine ratio has been done. No one should change medications based on a guideline without clinical advice.
Is there proof that universal screening improves outcomes? Not from a randomized trial of the screening strategy itself. The recommendation reflects expert consensus on existing evidence about the link between the two diseases.
