The European Society of Cardiology and the European Renal Association have issued their first joint guidelines calling for every patient diagnosed with cardiovascular disease to be routinely screened for chronic kidney disease, reflecting mounting evidence that the two conditions accelerate each other. The guidelines were presented at the ESC Congress 2026 in Munich and published in the European Heart Journal.
Under the new recommendations, every patient diagnosed with cardiovascular disease should be tested for kidney function at diagnosis, using a blood test for estimated glomerular filtration rate and a urine test for the albumin-to-creatinine ratio — two inexpensive, widely available measures that guideline authors say are inconsistently used in cardiology practice today. Chronic kidney disease affects an estimated 100 million people across Europe, according to the society, and can worsen cardiovascular outcomes even in patients whose heart disease is otherwise well managed, while cardiovascular disease can likewise accelerate kidney decline.
A five-step framework
The guidelines organize their recommendations around a five-step framework the authors call "STAMP on CKD": screen, triage, address CKD risk, modify cardiovascular management, and plan health services. After screening, patients are triaged by risk using validated scoring systems, then started early on therapies with dual heart-and-kidney benefit, including RAS inhibitors, SGLT2 inhibitors and statin-based therapy, with medication doses adjusted as needed for reduced kidney function. The final step calls for closer coordination between cardiology and nephrology teams, rather than treating the two conditions in separate silos.
"The good news is that there have been major advances over the last few years, which mean there are now several simple treatments that can substantially lower the risk of both cardiovascular and kidney complications."
Kevin Damman, University Medical Centre Groningen, co-chair of the guideline task force
Task force co-chair William Herrington of the University of Oxford said the update is meant to shift practice patterns that have lagged behind the science. Many patients with chronic kidney disease are already under a cardiologist's care, he noted, and the guidelines aim to increase routine use of kidney and urine testing among those patients rather than leaving screening to nephrology alone.
The document is the first dedicated ESC guideline devoted specifically to the overlap between cardiovascular and kidney disease, developed jointly with the European Renal Association. It follows several years of trial data showing that SGLT2 inhibitors and newer RAS-pathway drugs, originally developed for diabetes or heart failure, also slow kidney function decline, evidence that has reshaped how cardiologists think about drugs many already prescribe routinely. Because the guidance is a consensus recommendation rather than a randomized trial in itself, its real-world effect will depend on how quickly hospitals and clinics adopt routine dual screening, and whether health systems outside Europe follow suit.
