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ESC and ERA Release First Cardiorenal Guidelines
Developing
In Short: The European Society of Cardiology and European Renal Association issued guidelines emphasizing integrated care for heart and kidney diseases.
The European Society of Cardiology (ESC) and the European Renal Association (ERA) have released their first joint guidelines for cardiorenal management, focusing on integrated care for heart and kidney diseases.
According to the guidelines, cardiologists should maintain protective therapies even if there is a mild initial drop in estimated glomerular filtration rate (eGFR) upon initiation, as long-term benefits outweigh short-term declines.
The guidelines recommend routine screening for silent kidney disease in cardiac patients, aggressive blood pressure targets, and standardizing multidrug protective regimens.
Damman, a key figure in the guideline development, noted that while the US guidelines focus on the progression from obesity to chronic kidney disease, the ESC/ERA guidelines cover the entire cardiovascular continuum.
The new guidelines also extend their scope to decompensated heart failure, providing guidance on in-hospital decongestion strategies and emphasizing the importance of timely evidence-based care for individuals with coronary angiography/contrast exposure in STEMI and high-risk NSTEMI.
What's still developing
- In this sense, the guidelines closely follow the 2026 joint US guidelines for cardiovascular-kidney-metabolic (CKM) syndrome published by the American Heart Association (AHA), American College of Cardiology (ACC), American Diabetes Association, and American Society of Nephrology.
- “What we propose in these guidelines is to use many classes of drugs that are already often used in chronic kidney disease [CKD] but also in cardiovascular disease [CVD]: RAS [renin-angiotensin system] inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal MRAs [mineralocorticoid receptor antagonists],” Damman said.
- The new ESC/ERA document outlines five core priorities for clinicians managing patients across the cardiorenal spectrum: While both guidelines unite cardiology and nephrology, their overarching clinical models diverge in notable ways: “Whereas [the US guidelines] are focusing on the start of obesity and then progressing to chronic kidney disease, we tackle the entire cardiovascular continuum,” Damman said.
- Janani Rangaswami, MD, a professor of medicine at George Washington University in Washington, DC, and member of the AHA/ACC CKM syndrome guideline writing group, also encouraged cardiologists to overcome fear of acute kidney metrics in order to deliver necessary care.
Sources
- Medscapelink