Cardiologists in Europe have been told to test every patient for kidney damage at the time cardiovascular disease is diagnosed, using two inexpensive tests that many heart patients never receive.
The European Society of Cardiology, working with the European Renal Association, issued its first guidelines on the two conditions together. The recommendations were published in the European Heart Journal and presented at the society's annual congress. They are European guidance, not American, which matters for how readers should interpret what follows.
The two tests are ordinary. One is an estimated glomerular filtration rate calculated from a blood creatinine measurement. The other is a urine albumin-to-creatinine ratio, which detects protein leaking into urine. Both are widely available in the United States, and both are inexpensive relative to almost anything else in cardiac care.
The Reason a Heart Doctor Should Be Looking at Kidneys
The clinical logic is that each disease accelerates the other, and the combination arrives earlier and hits harder than either alone.
Task force chair Kevin Damman, an associate professor at University Medical Centre Groningen in the Netherlands, said kidney disease can accelerate cardiovascular disease and the reverse, "resulting in cardiovascular events and the need for dialysis much earlier in life." The society estimates that about 100 million people in Europe have chronic kidney disease, which it defines as abnormalities in kidney structure or function that persist for at least three months and affect a person's health.
His counterpart on the task force, Professor William Herrington of the University of Oxford, framed the practical problem as one of who is doing the looking. Many patients with kidney disease are treated by cardiologists, he noted, and the guidelines aim to increase the use of kidney function and urine albumin testing in patients with cardiovascular disease so that at-risk patients can be identified and treated appropriately for both conditions.
The task force organized its advice around an acronym it calls STAMP on chronic kidney disease, covering screening, triage, addressing kidney risk, modifying cardiovascular management, and planning health services. Screening comes first because nothing else in the sequence works without it.
An American Number That Explains Why Screening Keeps Getting Missed
The guidelines are European, but the underlying gap is not. According to the Centers for Disease Control and Prevention, an estimated 14 percent of United States adults, roughly 37 million people, have chronic kidney disease. About 87 percent of adults aged 20 and older with the condition do not know they have it.
That figure is the entire argument for routine testing compressed into one statistic. Chronic kidney disease is largely silent in its earlier stages. It does not usually announce itself with pain or a visible symptom, which is why a laboratory test rather than a patient complaint is what finds it. The federal agency maintains its own guidance on screening for kidney disease aimed at clinicians, and it identifies diabetes and high blood pressure as the conditions that should prompt testing.
The federal data also show where the burden concentrates. The condition is far more common in adults aged 65 and older, at 34 percent, than in adults aged 45 to 64, at 13 percent. It is more common in non-Hispanic Black adults, at 22 percent, than in non-Hispanic White adults at 13 percent or Hispanic adults at 12 percent. About 38 percent of adults with diabetes and 21 percent of adults with high blood pressure are estimated to have chronic kidney disease.
Readers with both a heart condition and diabetes or high blood pressure therefore sit at the intersection the guidelines are aimed at.
Treatments That Already Exist and Doses That May Need Adjusting
The guidelines do not call for a new drug. They call for earlier use of medicines that are already on pharmacy shelves.
Damman pointed to the early use of "RAS inhibitors and SGLT2 inhibitors alongside statin-based therapy" as particularly important and effective. Those categories include widely prescribed blood pressure medicines and a class originally developed for diabetes that has since shown kidney and cardiovascular benefit.
The document also addresses the reverse problem. Reduced kidney function changes how the body clears certain drugs, so some standard cardiovascular treatments need dose adjustment or substitution in patients with kidney impairment. A patient who learns they have reduced kidney function may reasonably ask a prescriber whether any current medication needs review, without stopping anything on their own.
Herrington emphasized communication between specialties and the involvement of patients and family caregivers in decisions. A patient version of the guidelines has been produced to support that.
Where This Leaves an American Patient in a Cardiology Waiting Room
Nothing here changes United States guidance. American clinicians follow their own professional recommendations, and a European society document does not alter standards of care, insurance coverage, or billing rules in this country.
What it does provide is a question worth asking. A patient with diagnosed cardiovascular disease can ask whether their kidney function and urine albumin have been checked, and when. Both tests are routine, and results are usually already in a patient portal if they were ordered. Someone with heart disease plus diabetes, high blood pressure, or age over 65 has the strongest case for asking.
Free or reduced-cost screening is often available through community health centers and federally qualified health centers for people without coverage. Anyone who has been told they have reduced kidney function should ask about referral to a nephrologist rather than assuming a single abnormal result settles the question, since a diagnosis requires abnormalities that persist for at least three months.
The task force said research is still needed to fill several gaps in the evidence, and the long-term effect of broader screening on outcomes has not been measured. Guidelines describe what a specialty society believes should happen, not what has been proven to happen when systems change.
Key Questions Answered
What are the two tests? An estimated glomerular filtration rate calculated from blood creatinine, and a urine albumin-to-creatinine ratio. Both are standard laboratory tests.
Who issued these guidelines? The European Society of Cardiology, in collaboration with the European Renal Association. They were published in the European Heart Journal and presented at the society's congress.
Do these guidelines apply in the United States? No. They are European recommendations. American clinicians follow separate professional guidance, and this document does not change United States standards of care or insurance rules.
Why does kidney damage matter for someone with heart disease? The task force describes the two conditions as accelerating each other, leading to cardiovascular events and the need for dialysis earlier in life than either condition alone would produce.
How many Americans have chronic kidney disease without knowing it? Federal estimates indicate about 87 percent of adults aged 20 and older with the condition are unaware of it. An estimated 37 million United States adults have it.
What should a heart patient do with this information? Ask a clinician whether kidney function and urine albumin have been tested and when. Do not start, stop or change any medication without speaking to a prescriber.
Which treatments does the guidance highlight? Earlier use of RAS inhibitors and SGLT2 inhibitors alongside statin-based therapy, plus adjustment of some cardiovascular drugs when kidney function is reduced.
