If you have been diagnosed with heart disease, you are likely aware of the critical importance of monitoring your blood pressure, cholesterol levels, and blood sugar. However, recent guidelines from the European Society of Cardiology (ESC), in partnership with the European Renal Association, suggest that it may now be necessary for healthcare providers to closely evaluate your kidney function as well.
The updated 2026 guidelines advocate for the screening of patients with cardiovascular disease for chronic kidney disease (CKD) at the time of diagnosis. This screening process includes two key tests: the estimated glomerular filtration rate (eGFR), which is derived from blood creatinine levels, and the urine albumin-to-creatinine ratio (UACR). The eGFR test assesses how effectively the kidneys are filtering blood, while the UACR can reveal early signs of kidney damage. This marks the first time the ESC has issued guidelines specifically addressing the combined management of cardiovascular and kidney diseases, underscoring the interconnected nature of these two organs.
Dr. Debdatta Majumdar, a Senior Consultant in Interventional Cardiology at Narayana RN Tagore Hospital in Kolkata, emphasizes that these recommendations establish routine kidney screening as an integral component of cardiovascular care. He explains, “This is the inaugural ESC guideline focused on the dual management of cardiovascular disease and CKD, developed alongside the European Renal Association. It standardizes the practice of assessing eGFR and UACR for every patient diagnosed with cardiovascular disease.”
Dr. Majumdar notes that CKD can often progress silently over time, making early detection crucial for preventing complications that could impact both kidney and heart health. The heart is responsible for circulating blood throughout the body, including to the kidneys, which filter blood, maintain fluid balance, and regulate blood pressure. Therefore, dysfunction in one organ can have detrimental effects on the other.
Dr. Udit Gupta, a Nephrology Consultant at ISIC Multispeciality Hospital, elaborates on this relationship, stating, “If the heart is weakened, it may not supply sufficient blood to the kidneys, impairing their function.” Conversely, compromised kidneys can lead to fluid retention and high blood pressure, which can further strain the heart. Conditions such as diabetes and hypertension exacerbate this connection, as they can harm both the heart and kidneys.
Dr. Majumdar describes the heart and kidneys as part of a closely-knit system where damage to one organ can adversely affect the other. “Both organs play a crucial role in regulating blood pressure, fluid levels, and circulation. Damage to one can directly impact the functioning of the other. High blood pressure can harm the kidneys’ filtering vessels, while failing kidneys may lead to increased fluid retention and toxins that elevate blood pressure, thereby further stressing the heart.”
The ESC guidelines highlight that CKD can accelerate the progression of cardiovascular disease, which in turn can worsen kidney health, thereby elevating the risk of heart-related events and kidney failure. One of the main challenges is that early-stage CKD typically presents no noticeable symptoms, which may result in patients receiving treatment for heart conditions without being aware of underlying kidney issues.
Dr. Aseem Dhall, Director and Head of Cardiac Sciences at ISIC Multispeciality Hospital, points out that kidney disease can often go undetected in heart patients, particularly in its initial stages due to the absence of clear symptoms. He identifies diabetes, hypertension, and aging as significant factors that can impair both organs. In a high-pressure cardiac environment, the focus may predominantly remain on heart health.
Dr. Majumdar suggests that kidney disease is likely underdiagnosed among individuals receiving heart treatment in India. He attributes this to several factors, including the country’s high prevalence of poorly managed diabetes and hypertension, limited access to nephrology services outside major urban areas, and the time and cost constraints faced in busy outpatient settings. As a result, while patients may regularly undergo tests like ECG or lipid profiles, they might not receive the urine tests necessary for detecting early kidney damage.
While a blood test can provide insights into kidney function, Dr. Gupta explains that urine tests are also essential because they provide different information. The blood test measures creatinine levels, which are used to estimate kidney filtering capacity via eGFR, while the urine test detects albumin, a protein that healthy kidneys typically prevent from leaking into urine. The presence of albumin can indicate early damage to the kidneys’ filtering system.
Dr. Majumdar advocates for the incorporation of both eGFR and UACR into standard cardiac care, as recommended by the ESC. He notes that both tests are affordable and widely accessible, eliminating cost as a barrier to routine screening. Detecting albumin in urine does not necessarily imply advanced kidney disease, but it does serve as a significant warning sign for individuals with cardiovascular conditions.
