ESC Congress 2026: First guideline puts CKD screening at center of cardiovascular care

Clinical takeaway: Patients with cardiovascular disease should be routinely screened for chronic kidney disease using both estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR). For those with CKD, early initiation of evidence-based therapies, especially renin-angiotensin system inhibitors, SGLT2 inhibitors, statin-based therapy, and selected use of finerenone and semaglutide, can substantially reduce the risk of both kidney failure and cardiovascular events.

The European Society of Cardiology (ESC), in collaboration with the European Renal Association, has released its first-ever guideline dedicated to the management of cardiovascular disease (CVD) and chronic kidney disease (CKD), highlighting the close and often underrecognized relationship between the two conditions. The guideline was published in the European Heart Journal on August 28 and is being presented at ESC Congress 2026.

A central message is that CKD should no longer be viewed as a nephrology problem alone. The guideline recommends routine screening for CKD in all patients with established CVD using blood creatinine-based eGFR and urine albumin-to-creatinine ratio measurements. The goal is earlier identification of high-risk patients who may benefit from therapies proven to slow kidney disease progression and reduce cardiovascular complications.

The document introduces the “STAMP on CKD” framework: Screen, Triage and stage CKD, Address CKD risk, Modify cardiovascular management, and Plan health services. Risk should be assessed using both kidney function and albuminuria, and patients with CKD stages G3-G5 should undergo formal kidney failure risk assessment to guide follow-up and specialist referral.

Therapeutically, the guideline strongly emphasizes early use of cardiorenal-protective medications. Maximally tolerated ACE inhibitors or ARBs are recommended for most patients with CKD, while SGLT2 inhibitors receive Class I recommendations for patients with CKD and type 2 diabetes and for many patients with non-diabetic CKD. The guideline also recommends finerenone for patients with CKD and type 2 diabetes who have persistent albuminuria, and semaglutide for selected patients with diabetic CKD to reduce both kidney disease progression and cardiovascular events.

For lipid management, the guideline recommends statin-based therapy for all patients with CKD and eGFR below 60 mL/min/1.73 m², regardless of baseline lipid levels, reflecting the elevated cardiovascular risk associated with CKD. Routine aspirin use for primary prevention is discouraged because bleeding risks may outweigh benefits.

The guideline also provides CKD-specific recommendations across the spectrum of cardiovascular disease. In heart failure, SGLT2 inhibitors are recommended regardless of ejection fraction, while guideline-directed medical therapy for HFrEF should generally be maintained despite modest declines in kidney function. In atrial fibrillation, direct oral anticoagulants are preferred over vitamin K antagonists in most patients with eGFR ≥15 mL/min/1.73 m² because they offer effective stroke prevention with lower bleeding risk.

Importantly, the authors stress that concerns about kidney function should not delay evidence-based cardiovascular care, including coronary angiography, revascularization, or acute coronary syndrome management when clinically indicated.

“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,” said guideline co-chair Kevin Damman, MD. Co-chair William Herrington, MD, added that broader use of kidney function and albuminuria testing will help identify more at-risk patients and ensure they receive the most appropriate therapies.

Source: Damman K, et al. (2026 Aug 28) Eur Heart J. 2026 ESC Guidelines for the Management of Cardiovascular Disease and Chronic Kidney Disease, in Collaboration With the European Renal Association (ERA)