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Jump to Key Points Chronic kidney disease (CKD) often remains undiagnosed in patients with cardiovascular disease (CVD), even though impaired kidney function can increase cardiovascular (CV) risk and affect treatment.
At the annual meeting of the German Society for Nephrology, Sibylle von Vietinghoff, MD, head of nephrology in the Department of Internal Medicine I at University Hospital Bonn in Bonn, Germany, discussed the importance of assessing kidney and CV health together and identifying kidney disease early. Her presentation was titled “The Kidney Protects the Circulatory System and Heart: Why Kidney Function Is So Important in Heart Disease.”
The heart and kidneys are closely connected and should be assessed together to optimize patient care.
The kidneys regulate several essential bodily processes, including urine excretion and blood volume regulation. “The heart and kidneys are therefore inextricably linked, enabling us to function as an organism,” said von Vietinghoff.
- CKD often undiagnosed in CVD; kidney + heart should be assessed together.
- CKM syndrome links kidney disease, CVD, metabolism; dedicated 2026 guidelines issued.
- Heart failure: ~30%-60% have renal impairment.
- CKD screening needs eGFR + UACR; creatinine alone is insufficient.
- BP control protects heart, kidneys, brain; sudden severe HTN in youth warrants renal workup.
Modern lifestyles can impose additional strain on the kidneys. For example, a high-sodium diet contributes to hypertension because the kidneys may have difficulty excreting excess sodium. Overweight and obesity are also associated with chronic inflammatory processes that can damage both the kidneys and the CV system. Consequently, kidney disease and CVD can exacerbate each other.
The close relationship between kidney function, CV health, and metabolism is reflected in the concept of cardiovascular-kidney-metabolic (CKM) syndrome. In 2026, the American Heart Association, the American College of Cardiology, the American Diabetes Association, and the American Society of Nephrology issued dedicated guidelines on the prevention, detection, evaluation, and management of CKM syndrome.
Although the underlying concept was already recognized, von Vietinghoff said that the terminology was intended to clarify these interconnections and encourage clinicians to take appropriate therapeutic action.
Many patients with CVD are unaware that they also have CKD because kidney disease often causes no specific symptoms in the early stages.
Von Vietinghoff illustrated the extent of the problem using heart failure, a common condition among older adults. “If you take a closer look at this group, you’ll find that 30%-60% have kidney impairment,” she said.
Early detection is important because CKD can increase the risk for complications, including kidney failure and CV events. Screening requires more than measuring serum creatinine to estimate the estimated glomerular filtration rate (eGFR). It also involves assessing urinary albumin excretion using the urine albumin-to-creatinine ratio (UACR).
“The eGFR is a calculated measure of kidney function,” said von Vietinghoff. “Protein excretion in the urine tells us how healthy or diseased the glomerulus is.”
Both measures are needed to assess kidney health comprehensively, according to von Vietinghoff. Together, eGFR and UACR help clinicians assess the risk for kidney failure and CVD.
Therefore, measuring serum creatinine alone is insufficient. Urine testing is as important as blood testing.
“I like to quote a colleague of mine who always says, ‘Protein in the urine is like oil under a car.’ And that’s exactly how it is: It simply doesn’t belong there. And if it’s there, it’s a warning sign,” she said.
Von Vietinghoff considers screening for CKD using eGFR and UACR particularly useful in high-risk groups, including patients with hypertension or diabetes. Assessing kidney function in these individuals helps clinicians evaluate kidney health and CV risk.
The importance of this approach is reflected in the 2026 European Society of Cardiology Guidelines for the management of CVD and CKD, published in collaboration with the European Renal Association on August 28, 2026. The guidelines recommend screening all patients with CVD for CKD using eGFR and albuminuria measurements.
The guidelines also recommend at least an annual reassessment of eGFR in patients with diabetes and those at high risk for worsening kidney function. Annual albuminuria testing is recommended for patients with diabetes, hypertension, decreased eGFR, or hematuria on urine dipstick, and when the presence or increase of albuminuria could affect treatment decisions.
High blood pressure (BP) is closely associated with kidney function. High BP can be a sign of reduced blood flow to the kidneys, but it can also damage the small blood vessels in the kidneys, impairing their ability to filter blood. This two-way relationship between high BP and kidney function has two important implications for clinical practice:
- In older patients with preexisting hypertension, maintaining BP within the target range helps protect the heart, kidneys, and brain by preserving the health of small blood vessels. “We need to consistently bring BP down to the target range because we know that this improves the health of all the small blood vessels,” she said. “This applies to the heart, the kidneys, and the brain as well.”
- In young and healthy individuals, a sudden onset of severe hypertension should prompt evaluation for an underlying cause, particularly kidney disease. “This is always a reason to investigate whether kidney disease is the cause, which can then possibly be treated to avoid serious consequences,” she said.
In her concluding remarks, von Vietinghoff reinforced the importance of managing elevated BP to protect vascular, renal, and cardiac health. “If your BP is too high, manage it consistently. This is extremely beneficial for vascular, kidney, and heart health.”
This story was translated from Coliquio, part of the Medscape Professional Network.
