Evaluating Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease: Written Recap

In this Managed Healthcare Executive K-Cast video series, Ty Gluckman, M.D., and Anitha Vijayan, M.D., discussed the underrecognized threat of cardiovascular disease and chronic kidney disease. Gluckman is the medical director at the Center for Cardiovascular Analytics, Research and Data Science at Providence St. Joseph Health. Vijayan is senior medical director at Intermountain Kidney Services and Nephrology at Intermountain Health.

As cardiovascular disease continues its reign as a leading killer, the nation faces a potential public health crisis with patients who have both heart disease and kidney disease. Gluckman and Vijayan emphasized the importance of integrated, preventive care that addresses patients’ risk factors before a nationwide epidemic occurs.

An estimated 20 million Americans are living with atherosclerotic cardiovascular disease, which includes coronary heart disease, stroke, and peripheral artery disease. But lurking beneath these sobering statistics is an even more troubling reality — 850 million people worldwide suffer from kidney disease, with 91% of Americans with the condition completely unaware they have it.

“Unlike the chest pain that signals a heart attack, kidneys don’t hurt as they deteriorate,” commented Vijayan. “We don’t have those signs for kidney disease, and hence it’s underdiagnosed. There is also a lack of awareness around the disease.”

The convergence of rising obesity and diabetes rates is creating what Gluckman described as a potential tsunami of cardiovascular and kidney disease. Current projections paint a dire picture, he says. By 2050, the prevalence of cardiovascular disease could surge from 12% to nearly 15% of the U.S. population, a 50% relative increase in just three decades.

The connection between cardiovascular and kidney disease stems from their shared risk factors and common pathogenic mechanisms. Traditional cardiovascular risk factors and their associated pathological processes — including high blood pressure, high cholesterol, obesity, physical inactivity, tobacco use, poor dietary choices and diabetes — are the same factors that damage the kidneys.

Approximately 80% of cardiovascular disease is preventable through lifestyle modifications and risk factor management, according to the American Heart Association’s “Life's Essential Eight” framework, which emphasizes control of blood pressure, blood sugar, cholesterol, weight, physical activity, diet, sleep and tobacco use.

“I would argue that if we spent more time focused on helping to prevent the onset of cardiovascular risk factors and then focused on evaluating and treating existing risk factors, it could go a long way to helping to reduce the total burden of cardiovascular disease and the acute manifestations that happen late in the disease process,” Gluckman said.

The missing link in detection

Improved detection and management of chronic kidney disease are crucial not just for preserving kidney function but also for preventing cardiovascular complications. Chronic kidney disease is the leading cause of death among those who have it, yet its importance is often underappreciated outside of nephrology, Gluckman said.

Despite clear clinical guidelines, a critical gap exists in how these interconnected diseases are identified and managed. Two key measurements — estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) — can detect problems early on, yet testing remains inconsistent, particularly for patients without diabetes.

The UACR test, which measures protein leakage in urine, serves as a powerful early warning system for both cardiovascular and kidney health. Typically, individuals excrete less than 30 milligrams of albumin daily; 30 to 300 milligrams indicates mild to moderate albuminuria, and a level above 300 milligrams represents significant albuminuria.

When albumin levels rise and kidney function declines, both heart disease risk and mortality rates climb substantially. Conversely, when therapies improve kidney function, cardiovascular outcomes also improve, demonstrating the intimate biological connection between these organ systems.

The eGFR measures kidney function, with normal function at approximately 100 milliliters per minute. Chronic kidney disease is staged based on eGFR decline: stage 2 (60-90), stage 3 (30-60, subdivided into 3A and 3B), stage 4 (15-30), and stage 5 (below 15, when dialysis consideration begins).

“We need to be doing a better job of measuring albumin in the urine, not just once, but on a more consistent basis, so as to drive effective use of therapy,” Gluckman said.

Vijayan pointed out that the test for albumin is a standard urine strip that is simple and easy to do. It could be possible for patients to test for albumin at home, “but it’s not something that’s ingrained into our screening practices yet,” she said. “In the future, if we were to have a home kit for monitoring eGFR for patients just starting medications, such as lisinopril, instead of going to a lab in two weeks, there could be routine monitoring at home.”

The challenge for managing the risks associated with cardiovascular disease lies in healthcare delivery itself. Current systems focus heavily on treating late-stage disease in isolation, with cardiologists, nephrologists and primary care physicians working in separate silos.

“If we were to redesign care today, we’d be looking at this from a population health perspective and asking how we prevent these diseases before they occur,” Gluckman argues.

Experts advocate for a restructuring of healthcare delivery that would break down barriers separating specialties and create integrated care teams to address cardiovascular, kidney, and metabolic health in a coordinated manner. Gluckman said a population health approach that focuses on early identification and prevention across kidney, heart and metabolic health is needed.

Several medications already show benefits across multiple conditions. Drugs such as ACE inhibitors, SGLT2 inhibitors, mineralocorticoid receptor antagonists and glucagon-like peptide 1 agents address diabetes, hypertension, heart failure and obesity simultaneously, making coordinated care particularly valuable.

The path forward requires better screening protocols, increased provider awareness, and healthcare systems structured around prevention rather than reactive treatment. With early detection and timely intervention using both lifestyle changes and pharmacologic therapies, it is possible to reduce risk to the heart, kidneys and other organs before irreversible damage occurs.

“It probably doesn’t come as a surprise that a biomarker assessing kidney health could give you insights about the heart, and biomarkers of cardiovascular health could give you insights about how the kidney is faring overall,” Gluckman says.

Effective management of these interconnected conditions demands a multidisciplinary team approach rather than relying solely on physicians. Clinical pharmacists, advanced practice providers, community health workers and other care team members can play key roles in evaluating and managing patients with overlapping cardiovascular, kidney and metabolic diseases.

This summary was written with the assistance of AI.