2026 ESC Guidelines Break New Ground: The First Cardio-Renal Roadmap

Cardiology just got its first stand-alone guideline for chronic kidney disease — a single document spanning the full range of CVD, built jointly with the European Renal Association.

Eur Heart J · ehag098 Published 28 Aug 2026 ESC + ERA Task Force doi.org/10.1093/eurheartj/ehag098

An estimated 100 million people in Europe live with chronic kidney disease, and the relationship with cardiovascular disease runs in both directions: CKD raises cardiovascular risk, and incident CVD — heart failure especially — sharply raises the risk of progressing to kidney failure. The task force frames its approach around a memorable acronym, STAMP: Screening, Triage and staging, Addressing CKD risk, Modifying CVD management, and Planning health services.

The headline practice change

Screen systematically

Every patient with CVD should now have eGFR and albuminuria checked — not eGFR alone. Albuminuria is underused but adds real risk-prediction value, particularly in patients with diabetes or hypertension, where the combination outperforms most single risk markers.

The new pharmacologic backbone

For most patients with CKD and elevated kidney-failure or cardiovascular risk:

• I AAn ACE inhibitor or ARB
• I APlus an SGLT2 inhibitor
• IIaA non-steroidal MRA and a GLP-1 receptor agonist in selected patients with diabetes and CKD

All layered on standard blood pressure control and consideration of a statin-based regimen.

Condition-specific highlights

• Heart failure — SGLT2 inhibitors are recommended regardless of ejection fraction; HFpEF patients with CKD should also get a non-steroidal MRA. Diuretic resistance rises with CKD stage, so decompensated patients often need higher-dose or combination diuretic strategies early.
• Blood pressure — target systolic BP of 120–129 mmHg (if tolerated) for eGFR ≥30, using out-of-office measurement to catch masked and white-coat hypertension. Below eGFR 30, targets stay individualized — the evidence base thins out fast.
• Atrial fibrillation — DOACs (favoring factor Xa inhibitors at low GFR) are preferred over vitamin K antagonists down to eGFR ≥15, offering better stroke protection with less bleeding risk.
• Kidney transplant candidates — a new simple cardiac risk-stratification algorithm to guide pre-transplant workup.

The honest gaps

The task force is candid about where the evidence runs out: dialysis populations remain badly under-represented in RCTs, and blood pressure targets below eGFR 30 rest on extrapolation rather than dedicated trial data.

Bottom line

This guideline pushes CKD screening and risk-modifying therapy squarely into general cardiology practice, rather than leaving it as a nephrology-only conversation. For most of us, the practical shift is smaller than it sounds — check albuminuria routinely, and think ACEI/ARB + SGLT2i as a default pairing rather than an afterthought.

Reference: Damman K, Herrington WG, et al. 2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease. Eur Heart J. 2026;ehag098.