New European guidelines say every heart patient should be screened for kidney disease

Cardiologists across Europe now have a formal directive to check kidney function in essentially every patient who walks through their door with heart disease, under a new clinical guideline released jointly by two of the continent’s leading medical societies. The recommendation grew out of mounting evidence that heart and kidney problems feed each other, often silently, until a patient ends up facing both a cardiovascular event and kidney failure at once. Because chronic kidney disease already affects an estimated 100 million people across Europe, the guideline’s authors say wider testing could catch a disease that is frequently invisible until it has already caused lasting damage.

The task force behind the new screening rule

The guidance was developed by the European Society of Cardiology together with the European Renal Association, marking the first time the two organizations have jointly published a dedicated guideline covering both conditions. The document was written by a task force of cardiologists and kidney specialists tasked with closing a long-standing gap in routine care: heart patients are typically monitored closely for blood pressure, cholesterol, and rhythm problems, but kidney function has often been checked only when symptoms already point to a problem.

Chronic kidney disease is defined clinically as abnormalities of kidney structure or function persisting for at least three months, and it raises the risk of a wide range of cardiovascular diseases on its own. The task force chairs described the two conditions as capable of accelerating each other, so that a patient with undiagnosed kidney trouble can face cardiovascular events and the need for dialysis far earlier in life than they otherwise would.

What the screening actually requires in practice

The core recommendation is straightforward: every patient diagnosed with cardiovascular disease should be tested for chronic kidney disease at the time of diagnosis, using a combination of a blood test to estimate glomerular filtration rate and a urine test to measure the albumin-to-creatinine ratio. Those two measurements together give doctors a much fuller picture of kidney health than either test alone, and both are already inexpensive and widely available in routine clinical settings.

The guideline organizes the approach around what its authors call the “STAMP on CKD” framework, covering five steps: screening at diagnosis, triaging patients by risk, addressing kidney disease risk directly, modifying cardiovascular treatment plans accordingly, and planning coordinated health services between cardiology and nephrology teams. That last step reflects a recurring theme in the guideline, that patients with both conditions often fall into gaps between specialties unless the two teams actively coordinate care.

Why earlier detection changes what doctors can do

The push for wider testing is grounded in newer treatment options that were not broadly available even a few years ago. Task force leaders pointed to drugs known as RAS inhibitors and SGLT2 inhibitors, used alongside statin-based therapy, as treatments that have been shown in recent trials to meaningfully lower the risk of both kidney and cardiovascular complications when started early. Detecting kidney disease sooner means these therapies can be introduced before a patient’s kidney function has already declined significantly, which the guideline’s authors argue is when they do the most good.

The guideline also outlines specific adjustments cardiologists should make to standard heart-disease treatment once a patient’s kidney function is compromised, including which medications may need dose changes because the kidneys can no longer clear them efficiently from the body. That level of detail is meant to give frontline cardiologists, who may see far more heart patients than dedicated kidney specialists do, clear guardrails for adjusting care without necessarily referring every patient out.

The scale of the problem the guideline is trying to address

Roughly 100 million people in Europe are estimated to live with chronic kidney disease, and the condition’s early stages typically produce no symptoms at all, which is precisely why it tends to go undiagnosed until it has already progressed. Because that population overlaps heavily with the tens of millions of Europeans already living with cardiovascular disease, the new screening recommendation is aimed less at a rare edge case than at a very large group of patients already sitting in cardiology waiting rooms.

According to the announcement from the European Society of Cardiology, the guideline was published in the European Heart Journal and presented at the ESC Congress in Munich in late August, alongside a companion patient-facing version meant to help people with cardiovascular disease understand their own kidney risk and take part in decisions about their care. The task force chairs said the goal is for the recommendations to reach not just specialists but the broader health system, including policymakers who decide how testing and follow-up care get funded and organized across national health services.

Whether hospitals and clinics move quickly to adopt universal kidney screening for heart patients will likely depend on how easily the two blood-and-urine tests can be folded into existing appointments, since both are already routine in many other areas of medicine. The guideline’s authors have framed the change as a relatively low-cost intervention with an outsized potential payoff: catching kidney disease months or years before it would otherwise surface, at a point when proven treatments can still change its trajectory.

This article was created with the assistance of AI and reviewed by an editor.

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