New European guidelines urge every heart patient to be tested for kidney disease

Overview

Updated Sep 7

In European medicine, the heart and kidney have been treated as separate problems. The first-ever joint guidelines from the European Society of Cardiology and the European Renal Association now treat them as one system that damages itself in a two-way cycle: kidney disease accelerates heart disease, and heart disease accelerates kidney failure.

The guidelines recommend that every patient diagnosed with cardiovascular disease get two cheap, routine tests: a blood test for estimated glomerular filtration rate, and a urine test for albumin-to-creatinine ratio. The goal is earlier detection of chronic kidney disease, a condition affecting roughly 100 million Europeans, so proven treatments can slow both diseases.

The treatment core is early use of RAS inhibitors, SGLT2 inhibitors, and statin-based therapy, all validated in recent trials to slow kidney decline and cut cardiovascular events. Catching the kidney disease patients do not know they have is the first step to getting them those drugs.

Why it matters

100 million Europeans with chronic kidney disease could be diagnosed years earlier if routine heart care adds two simple tests.

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Key Indicators

100 million

Europeans estimated to have chronic kidney disease

ESC estimates about 100 million people in Europe live with CKD.

Routine screening tests recommended for heart patients

Blood eGFR and urine albumin-to-creatinine ratio, both simple and inexpensive.

First-ever

Joint ESC-ERA cardiovascular-kidney guidelines

First dedicated ESC guidelines on CVD with CKD, published August 2026 in the European Heart Journal.

Voices

Curated perspectives — historical figures and your fellow readers.

People Involved

Kevin Damman

Co-chair, ESC-ERA CVD-CKD task force

Associate Professor at University Medical Centre Groningen, Netherlands

William Herrington

Co-chair, ESC-ERA CVD-CKD task force

Professor at University of Oxford, UK

Organizations Involved

European Society of Cardiology

Medical society

Issued first joint CVD-CKD guidelines

Professional body representing over 100,000 cardiology professionals across Europe.

European Renal Association

Medical society

Co-developer of the new guidelines

Professional body for nephrologists across Europe, founded as the European Dialysis and Transplant Association.

European Heart Journal

Medical journal

Published the new guidelines

Peer-reviewed cardiology journal published by Oxford University Press.

Timeline

August 2026 September 2026

4 events Latest: September 6th, 2026 · 2 months ago

Tap a bar to jump to that date

September 2026
Coverage frames the 'heart-kidney cycle' story for wide audiences
Latest Media

News reports emphasize the two-way damage cycle and the simple blood and urine tests that could break it.
September 6th, 2026
ESC press alert circulates on screening advice
Media

ScienceDaily and other outlets pick up the recommendation that every heart patient be tested for kidney disease.
September 2nd, 2026
August 2026
Guidelines presented at ESC Congress 2026 in Munich
Conference

Task force chairs Damman and Herrington outline the two-test screening recommendation to attending cardiologists.
August 29th, 2026
ESC and ERA publish first joint CVD-CKD guidelines
Publication

European Heart Journal carries new guidelines built on the STAMP-on-CKD framework: screen, triage, address risk, modify treatment, plan services.
August 28th, 2026

Scenarios

Routine kidney screening becomes standard in European heart care

Likely Resolves by End of 2028

Discussed by: ESC task force chairs Kevin Damman and William Herrington, who frame improved screening as the guidelines' primary goal

If cardiologists and nephrologists adopt the two tests, kidney disease is diagnosed years earlier, CKD progression slows, and dialysis is delayed. National cardiology societies across Europe integrate eGFR and urine albumin testing into standard cardiovascular workups, and registry data begin showing rising screening rates.

Guidelines drive new combination-therapy research

Possible Resolves by End of 2027

Discussed by: Clinical trialists citing the guidelines' emphasis on early RAS inhibitor, SGLT2 inhibitor, and statin combination therapy

The guidelines push a three-drug combination as the evidence-backed default for CVD patients with CKD. If uptake is strong, sponsors launch new trials testing the combination against individual agents in broader populations, generating data that could cement the regimen as protocol.

Implementation stalls without system changes

Possible Resolves by End of 2029

Discussed by: Health-services researchers noting the guidelines' call for cross-specialty coordination and patient engagement

Screening without treatment capacity, funding limits, and strained nephrology services keep the guidelines aspirational. The fourth pillar of STAMP, planning health services, fails to materialize as health systems struggle to route newly identified CKD patients to nephrologists in time.

Historical Context

3 moments from history that rhyme with this story — and how they unfolded.

2026

US CKM syndrome guideline (2026)

The American Heart Association, American College of Cardiology, American Diabetes Association, and American Society of Nephrology issued a joint guideline for cardiovascular-kidney-metabolic syndrome, retiring and replacing the 2013 obesity guideline. It framed obesity, type 2 diabetes, chronic kidney disease, and cardiovascular disease as one interconnected condition.

Then

US clinicians gained a unified framework for treating metabolic, kidney, and heart conditions together.

Now

The guideline established a multi-organ, multi-specialty standard that became the reference for integrated care.

Why this matters now

The same year, on the other side of the Atlantic, the ESC and ERA produced their own joint framework. Both efforts converge on the same conclusion: heart, kidney, and metabolic disease belong to one care pathway, not separate silos.

2019-2023

SGLT2 inhibitor trials (2019-2023)

Trials including DAPA-CKD, EMPA-KIDNEY, and heart failure studies found that SGLT2 inhibitors protected both the kidneys and the heart, cutting kidney decline and cardiovascular events in patients with and without diabetes. RAS inhibitors and statins had long shown similar dual benefits.

Then

A class of diabetes drugs became standard therapy for heart and kidney protection.

Now

The trials provided the evidence base that makes the new ESC-ERA combination-therapy recommendation possible.

Why this matters now

The ESC guidelines lean directly on these trials. The drugs existed before; what changed is the confidence to combine them early in all CVD patients with kidney disease, which is exactly what the new guidance prescribes.

2004-2008

Cardiorenal syndrome consensus (2004-2008)

The Acute Dialysis Quality Initiative and later the consensus groups formally defined cardiorenal syndromes: the clinical conditions where acute or chronic dysfunction of one organ induces dysfunction of the other. The definitions gave doctors a shared diagnostic language for a link long observed in practice.

Then

Clinicians gained formal criteria for diagnosing heart-kidney interaction syndromes.

Now

The concept legitimized joint management of the two organs and laid groundwork for cross-specialty guidelines.

Why this matters now

The ESC-ERA guidelines operationalize what the cardiorenal syndrome consensus named two decades ago. The diagnostic link is now embedded in routine screening recommendations for every heart patient.