Heart disease and kidney disease may appear to affect very different parts of the body, but the two are closely connected, and problems with one can make problems with the other worse.

New guidelines from the European Society of Cardiology (ESC), developed with the European Renal Association, are urging doctors to pay closer attention to this relationship. The recommendations call for people with cardiovascular disease (CVD) to be screened for chronic kidney disease (CKD), potentially helping identify problems before they become more serious.

The scale of the issue is considerable. An estimated 100 million people across Europe have CKD, according to the ESC. The condition can substantially increase the risk of cardiovascular disease, while existing heart problems can also contribute to worsening kidney function.

How Are the Heart and Kidneys Connected?

The heart pumps blood throughout the body, including to the kidneys, which filter waste and excess fluid from the bloodstream. When cardiovascular health deteriorates, reduced blood flow and other changes can place additional strain on the kidneys.

At the same time, impaired kidney function can contribute to problems that affect the cardiovascular system. Kidney disease is associated with risk factors such as high blood pressure and abnormal cholesterol, while changes in fluid balance and blood vessels can further increase cardiovascular strain.

The National Kidney Foundation describes the relationship as bidirectional: heart disease can affect the kidneys, and kidney disease can affect the heart.

Professor William Herrington, of the University of Oxford, said many people with CKD are treated by cardiology teams, making kidney testing an important part of cardiovascular care.

'With improved screening, more at-risk patients can be identified, and the most appropriate treatments for both CKD and CVD can be prescribed,' he said.

What Do the New Guidelines Recommend?

The ESC guidelines introduce a strategy called 'STAMP on CKD': Screen, Triage, Address CKD Risk, Modify CVD Management, and Plan Health Services.

Screening is the first step. The guidelines recommend that people with CVD be tested for CKD when their cardiovascular condition is diagnosed. This involves a blood test to estimate kidney filtration and a urine test to measure albumin, a protein that can indicate kidney damage.

Doctors can then assess a person's likelihood of developing kidney failure and cardiovascular complications and determine which treatments may be appropriate.

Can Treatment Protect Both Organs?

There are treatments that can help reduce risks to both the heart and kidneys. Associate Professor Kevin Damman of University Medical Centre Groningen said early use of renin-angiotensin system (RAS) inhibitors and SGLT2 inhibitors, alongside statin-based therapy, is particularly important.

'There have been major advances over the last few years,' Damman said, adding that several relatively simple treatments can substantially lower the risk of cardiovascular and kidney complications.

The guidelines also stress that treatment may need to be adjusted when kidney function is reduced, because the kidneys help clear some medicines from the body.

For patients, the message is straightforward: heart health and kidney health should not be considered separately. Managing blood pressure, cholesterol, diabetes, and other cardiovascular risk factors, and asking about appropriate kidney testing, could help identify problems earlier.

The ESC also recommends closer communication between cardiologists, kidney specialists, and other healthcare professionals, particularly for people at higher risk.

Frequently Asked Questions

  • How are the heart and kidneys connected?
    The heart pumps blood to the kidneys, which filter waste from the bloodstream. Poor cardiovascular health can strain the kidneys, while impaired kidney function can affect the heart.
  • What is the 'STAMP on CKD' strategy?
    It is a strategy recommended by the ESC for managing cardiovascular and kidney health, involving screening, triage, addressing CKD risk, modifying CVD management, and planning health services.
  • Can treatment protect both the heart and kidneys?
    Yes, treatments such as RAS inhibitors, SGLT2 inhibitors, and statin-based therapy can reduce risks to both organs.
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