If you have heart disease, you probably already know that tracking your blood pressure, cholesterol and blood sugar is important, too. But your doctor may now need to check one more organ closely: your kidneys.

The new 2026 guidelines from the European Society of Cardiology (ESC), developed in collaboration with the European Renal Association, recommend that patients with cardiovascular disease be screened for chronic kidney disease (CKD) at diagnosis.

The screening involves two tests: estimated glomerular filtration rate (eGFR), calculated from blood creatinine, and a urine albumin-to-creatinine ratio (UACR). The first gives doctors an idea of how well the kidneys are filtering blood, while the second can detect signs of kidney damage. This is the first dedicated ESC guideline on managing cardiovascular disease and chronic kidney disease together. The thinking behind it is simple: the heart and kidneys don’t work in isolation, and a problem in one can make the other worse.

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Speaking with indianexpress.com, Dr Debdatta Majumdar, Senior Consultant – Interventional Cardiology, Narayana RN Tagore Hospital, Narayana Health, Kolkata, says the recommendation formalises kidney screening as part of cardiovascular care.

“This is the first-ever ESC Guidelines on managing cardiovascular disease and chronic kidney disease, developed with the European Renal Association. It formalises routine screening – testing estimated glomerular filtration rate from blood creatinine plus urine albumin-to-creatinine ratio in every CVD patient at diagnosis.”

The benefit, he says, is that CKD—which can remain silent for a long time—can be detected earlier, when there is more opportunity to prevent both kidney and cardiovascular complications.

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Why are your heart and kidneys so closely linked?

The heart pumps blood around the body, including to the kidneys. The kidneys, meanwhile, filter the blood, regulate fluid balance and contribute to blood-pressure control.

So when one organ starts struggling, the other can be affected.

“If the heart is weak, the kidneys may receive less blood and struggle to function properly,” explains Dr Udit Gupta, Consultant, Nephrology, Renal Sciences, ISIC Multispeciality Hospital, speaking to indianexpress.com.

The reverse can happen too. Damaged kidneys can cause fluid to build up and contribute to high blood pressure, putting additional stress on the heart.

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Diabetes and hypertension make the connection even more important because they can damage both organs.

For patients, it (new guideline) is a reminder to keep track of blood pressure, blood sugar and kidney health, even when they feel well

Dr Majumdar describes the relationship as an interconnected system in which damage can move in both directions.

“The heart and kidneys work as a single interconnected system regulating blood pressure, fluid balance, and circulation, so damage to one organ places direct strain on the other. High blood pressure and poor blood flow injure the kidneys’ filtering vessels, while failing kidneys retain fluid and toxins that raise blood pressure and burden the heart further.”

The ESC also notes that CKD can accelerate cardiovascular disease and cardiovascular disease can, in turn, worsen kidney health, increasing the risk of cardiovascular events and kidney failure. ESC press release

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Why might kidney disease be missed in heart patients?

The biggest problem is that early CKD often has no obvious symptoms. A person can therefore be receiving treatment for heart disease while an underlying kidney problem goes unnoticed.

“Kidney disease can be missed in people with heart disease, particularly in its early stages. This is because early kidney problems often do not cause clear symptoms,” says Dr Aseem Dhall, Director & HOD, Cardiac Sciences, ISIC Multispeciality Hospital, speaking to indianexpress.com.

He points to diabetes, high blood pressure and ageing as factors that can affect both organs. In a busy cardiac setting, the focus may naturally remain on the heart.

The issue may be particularly relevant in India.

“Very likely yes. Routine ACR/eGFR testing isn’t standard in most Indian cardiology OPDs; CKD is largely asymptomatic until advanced,” says Dr Majumdar, when asked if he thinks kidney disease is underdiagnosed among people being treated for heart disease in India.

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He adds that India’s high burden of poorly controlled diabetes and hypertension, limited access to nephrology referral outside major cities, and time and cost pressures in busy outpatient departments can all contribute to kidney disease being missed.

In other words, a patient may routinely have an ECG or lipid profile checked without necessarily having the urine test that could reveal early kidney damage.

Why do you need both a blood and urine test?

If a blood test can assess kidney function, why is a urine test necessary too? Because they answer different questions.

The blood test measures creatinine, which is used to estimate the kidneys’ filtering capacity through eGFR.

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The urine test looks for albumin leaking into the urine. Healthy kidneys generally prevent significant amounts of this protein from passing through. Its presence can be an early sign of damage to the kidney’s filtering system.

Dr Gupta says the tests provide “different but complementary information”.

Importantly, early kidney damage can exist even when kidney function appears normal. That is why the ESC recommendation is for both eGFR and UACR rather than relying on creatinine alone.

Dr Majumdar also believes these tests are practical to introduce into routine cardiac care.

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“The ESC guidelines recommend screening all CVD patients at diagnosis using eGFR plus urine albumin-to-creatinine ratio, not creatinine alone. Both tests are cheap and widely available, so cost isn’t a barrier.”

What does albumin in your urine mean for your heart?

Finding albumin in urine does not automatically mean that someone has advanced kidney disease. But in a person with cardiovascular disease, it can be an important warning sign.

“Albumin in the urine, known as albuminuria, can be an early sign that the kidney’s filtering system is being damaged,” Dr Gupta explains.

Albuminuria signals vascular damage, warranting earlier kidney-based risk assessment and treatment to protect heart and kidneys

Even a small amount can warrant attention, particularly when a person also has heart disease, diabetes or high blood pressure.

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But there is another reason cardiologists should care about it: albuminuria is also associated with increased cardiovascular risk.

Dr Majumdar says this should change how doctors think about a patient’s overall risk.

“It means their cardiovascular risk is higher than standard scores suggest. Albuminuria signals early vascular damage beyond just the kidneys, so ESC guidelines call for reassessing risk using scores that incorporate kidney function.”

He describes it as “a red flag that should actively change management, not just a kidney finding.”

So an abnormal urine result is not simply something to be filed under “kidney health”. It can provide additional information about a patient’s cardiovascular risk as well.

Could finding kidney disease change your heart treatment?

Yes. Screening matters because identifying CKD can influence what happens next.

The ESC guidelines emphasise early use of treatments that can reduce both cardiovascular and kidney complications in appropriate patients, including RAS inhibitors and SGLT2 inhibitors, alongside statin-based therapy. Treatment depends on the patient’s individual condition and kidney function. ESC clinical practice guidelines

Kidney function can also affect the way some cardiovascular medicines are prescribed, including whether doses need to be adjusted.

Dr Dhall says early detection gives doctors an opportunity to look at the patient’s blood pressure, diabetes control, medicines, diet and other risk factors together.

“By managing these risks early, we may slow kidney damage and reduce the chances of heart failure, hospitalisation and other serious cardiovascular complications,” the cardiologist says.

Dr Majumdar believes the potential benefit is especially relevant in India, where detecting CKD earlier could also help reduce more serious complications later.

“Routine testing would let doctors start RAS inhibitors and SGLT2 inhibitors alongside statins earlier – proven to slow kidney decline and cut cardiovascular events.”

Given India’s diabetes and hypertension burden and limited access to nephrology care outside major cities, he says early detection could help reduce the need for more costly interventions such as dialysis and prevent repeat cardiac events.

What happens if the test is abnormal?

An abnormal kidney test does not automatically mean kidney failure.

“First, there is no need to panic. An abnormal result does not always mean serious or permanent kidney disease,” says Dr Gupta.

Depending on the result and the patient’s overall health, the doctor may recommend repeat testing or additional investigations. Some patients may also need to see a nephrologist.

For heart patients, controlling the factors that affect both organs remains important. That means keeping blood pressure and diabetes under control, taking prescribed medicines as advised and avoiding unnecessary painkillers that can affect kidney function.

The new ESC guidelines also call for better coordination between cardiologists and nephrologists for patients who have both conditions. The guidelines’ broader framework, called “STAMP on CKD”, stands for Screen, Triage, Address CKD Risk, Modify CVD management and Plan health services. ESC press release

The idea is to identify CKD early, understand the level of risk, treat it appropriately and adjust cardiovascular care when necessary.

For patients, the takeaway is not that every person with heart disease has kidney disease. It is that kidney disease can be silent, and a simple blood-and-urine check may uncover it before it becomes a bigger problem.

As Dr Dhall puts it, “The key message is that heart health cannot be looked at in isolation.”

With the new ESC recommendation, checking the kidneys could become an important part of checking the heart too.