Screening and Treatment for Chronic Kidney Disease in Heart Disease Patients Needs to Be Expanded

Why It Matters

Undiagnosed CKD amplifies cardiovascular risk, so expanding screening and therapy can reduce mortality and health‑system costs.

Key Takeaways

• eGFR alone misses half CKD cases in CAD patients
• Combined eGFR and UACR screening identifies more CKD
• Only ~70% receive RAAS inhibitors; SGLT2 use 13‑20%
• GLP‑1RA usage below 1% despite proven cardio‑renal benefits
• Early CKD detection reduces cardiovascular mortality risk

Pulse Analysis

Chronic kidney disease is emerging as a silent accelerator of cardiovascular events, particularly among patients with established coronary artery disease. While the prevalence of CKD has risen globally, its detection in cardiac cohorts remains suboptimal. The INTERASPIRE study, spanning 14 countries and all WHO regions, highlighted that traditional reliance on estimated glomerular filtration rate alone leaves roughly 50% of CKD cases unnoticed. Incorporating urinary albumin/creatinine ratio into routine assessments provides a more comprehensive risk profile, enabling clinicians to intervene earlier.

The therapeutic gap is equally striking. Although RAAS inhibitors were prescribed to about 70% of the cohort, the adoption of newer cardio‑renal agents—SGLT2 inhibitors and GLP‑1 receptor agonists—lagged far behind, with usage rates of 13‑20% and under 1% respectively. These drug classes have demonstrated robust reductions in heart failure hospitalizations and renal decline, yet their integration into post‑CAD care pathways remains limited. Barriers include clinician awareness, reimbursement constraints, and fragmented care models that separate cardiology from nephrology.

Addressing these shortcomings offers a clear value proposition for health systems and pharmaceutical innovators. Expanding guideline‑driven screening to include both eGFR and UACR can double CKD detection rates, while bundled care models that align cardiology and nephrology services can accelerate the uptake of evidence‑based therapies. For investors and policymakers, the convergence of rising CKD prevalence, proven drug efficacy, and existing care gaps signals a sizable market opportunity to improve outcomes and curb the escalating costs of cardiovascular disease.