The European Society of Cardiology (ESC) and European Renal Association (ERA) have published their first joint guideline on the management of cardiovascular disease (CVD) and chronic kidney disease (CKD), recommending universal CKD screening for all patients with newly diagnosed CVD using both estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR).¹
The guideline was published in the European Heart Journal and will be presented at ESC Congress 2026 in Munich, Germany.¹
CVD and CKD frequently coexist and accelerate one another, often resulting in cardiovascular events and progression to kidney failure earlier in life. Despite this overlap, kidney function and albuminuria testing have historically been underused in cardiology practice, leaving many patients with unrecognized CKD.¹
“Many patients with CKD are treated by the cardiology community and the new ESC Guidelines aim to increase the use of kidney function and urine albumin testing in patients with CVD. With improved screening, more at-risk patients can be identified and the most appropriate treatments for both CKD and CVD can be prescribed,” Task Force Chair William Herrington, University of Oxford, said in a statement.
STAMP Framework and Universal CKD Screening Recommendation
The guideline is organized around the STAMP on CKD acronym: Screen, Triage and staging of CKD, Address CKD and CVD risk, Modify CVD management, and Plan health services.² Screening is recommended for all patients with CVD at diagnosis, using both eGFR and uACR, since quantitative uACR offers improved sensitivity and specificity over qualitative dipstick testing.² At least annual re-screening is recommended for patients with diabetes, CKD, or CVD, with more frequent re-testing considered for patients at risk of acute kidney injury or receiving renally excreted drugs with a narrow therapeutic window.²
The Task Force also recommends triage using validated CVD risk scores incorporating kidney function and albuminuria, along with the Kidney Failure Risk Equation in CKD categories G3 through G5, to guide timely nephrology referral.²
Risk-Modifying Therapy Recommendations for CVD and CKD
For addressing risk, the guideline recommends early use of proven, cost-effective risk-modifying therapies shown to slow CKD progression and reduce cardiovascular events.²
Kevin Damman, MD, PhD, task force co-chair and associate professor at University Medical Centre Groningen, the Netherlands, framed the guideline against a backdrop of recent therapeutic advances. "The good news is 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," Damman said.¹ "Early use of drugs called RAS inhibitors and SGLT2 inhibitors alongside statin-based therapy are particularly important and effective.”
Suitably intensive statin-based therapy, with or without ezetimibe, is recommended routinely for patients with CKD not on dialysis, irrespective of lipid levels, to reduce atherosclerotic cardiovascular risk.²
An ACE inhibitor or angiotensin receptor blocker, plus an SGLT2 inhibitor, is recommended for most patients with CKD, and SGLT2 inhibitors can be initiated at an eGFR of 20 mL/min/1.73 m2 or higher and continued below this threshold until kidney replacement therapy begins.²
Non-steroidal mineralocorticoid receptor antagonist therapy (finerenone) and GLP-1 receptor agonist therapy (semaglutide) are recommended for patients with CKD, type 2 diabetes, and albuminuria to further reduce the risk of CKD progression and cardiovascular events.² The guideline also addresses disease-specific modifications: existing stroke and bleeding risk-prediction tools for atrial fibrillation perform poorly in CKD, and direct oral anticoagulants are preferred over vitamin K antagonists in patients with an eGFR above 30 mL/min/1.73 m2.²
Heart Failure, Coronary, and Procedural Considerations
The guideline also addresses disease-specific management modifications across major cardiovascular conditions.² For heart failure, foundational medical therapies remain similarly effective in relative terms in patients with and without CKD, and the high absolute risk seen in CKD predicts large absolute treatment benefit.² In patients with volume overload, sufficiently high loop diuretic dosing, measurement of diuretic response, and combination diuretic therapy are recommended to achieve maximal decongestion in decompensated heart failure with CKD.²
For chronic and acute coronary syndromes, an individualized approach to diagnostic coronary imaging is recommended in patients with CKD, and management generally follows an initial conservative strategy of optimal medical therapy.² When revascularization is indicated, individualized decision-making is required regarding percutaneous versus surgical revascularization.²
Abbreviated dual antiplatelet therapy duration, 1 to 3 months rather than the conventional 6, should be considered for patients with CKD and chronic coronary syndrome undergoing elective percutaneous coronary intervention to reduce bleeding risk, and serial troponin assessment is emphasized given the elevated bleeding risk affecting antiplatelet therapy choice in this population.²
For atrial fibrillation, cardioversion success appears unaffected by CKD stage, though recurrence is high, and catheter ablation may serve as an effective alternative.² Both rate- and rhythm-control strategies require individualized approaches in CKD, accounting for drug pharmacokinetics, electrolyte imbalance, and structural heart disease prevalence.²
For contrast-induced acute kidney injury, permanent harm is relatively rare, so the risk is nearly always outweighed by the benefits of diagnostic imaging and therapeutic intervention.² Iso-osmolar or low-osmolar contrast media, combined with contrast-sparing protocols, are indicated when eGFR is below 30 mL/min/1.73 m2, with periprocedural intravenous hydration also considered.²
The guideline also calls for closer coordination between cardiology and nephrology and includes a companion patient version intended to support shared decision-making.¹
“CVD and CKD are major burdens on patients, healthcare systems and society,” wrote the Task Force Chairs. “The key messages in these guidelines should be noted by all relevant healthcare stakeholders and policymakers, and research planned to fill several gaps in the evidence. Raising awareness will help realise the hope that the guidelines will lead to important individual and societal improvement for those with, or at risk of, CVD and CKD.”
References:
European Society of Cardiology. New ESC Guidelines recommend all patients with heart disease are tested for kidney disease. Published August 28, 2026. Accessed August 29, 2026.
Damman K, Herrington W, et al; ESC/ERA Task Force. 2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease, in collaboration with the European Renal Association. Eur Heart J. 2026. doi:10.1093/eurheartj/ehag098
