Early Detection and Interconnected Risk: The Role of Albuminuria in Kidney and Cardiovascular Disease

In this Q&A with Pharmacy Times, Eugene Wright, MD, discusses the critical relationship between chronic kidney disease, cardiovascular disease, and conditions such as hypertension and type 2 diabetes, emphasizing their shared vascular pathways and compounded risks. He explains how damage from diabetes and elevated blood pressure creates a cycle of worsening kidney and heart function, increasing the likelihood of serious complications. Wright highlights albuminuria, measured by urine albumin-to-creatinine ratio (uACR), as an early warning sign of systemic vascular dysfunction—not just kidney disease—and underscores its importance in identifying at-risk patients sooner. Early detection through uACR testing allows for timely interventions that can slow disease progression and reduce cardiovascular events.

Pharmacy Times: To start, can you explain the connection between chronic kidney disease, cardiovascular disease, and conditions like hypertension and type 2 diabetes, and why these patients are particularly vulnerable to complications?

Eugene Wright, MD: The heart and kidneys are connected through the cardiovascular system, with the heart pumping blood to the kidneys and the kidneys filtering waste from the blood, which in turn helps the heart. The kidneys also help regulate blood pressure. The kidneys and the heart have a 2-way relationship, and the heart relies on the kidneys to regulate blood pressure and fluid balance, while the kidneys need the heart to circulate oxygen-rich blood for filtration. This interdependence is why a problem in one organ can negatively affect the others. However, conversely, improvement in one organ system leads to improvement in the others.

Type 2 diabetes damages small vessels, which can lead to both chronic kidney disease and cardiovascular disease. High blood pressure, or hypertension, increases the strain in the blood vessels and adds to the increased workload for the heart. The heart pumps blood to the kidneys so that impurities and waste can be filtered and eliminated. A normally functioning kidney eliminates waste and regulates blood pressure that the heart uses to pump blood. When the kidney is not functioning properly, waste is not effectively eliminated, and blood pressure is increased. This increased blood pressure further injures the kidneys, and the cycle repeats itself.

Therefore, people with hypertension are twice as likely to have cardiovascular disease, and people with diabetes are 4 times as likely to have cardiovascular disease. The risk of cardiovascular disease is compounded even further if you have both.

Pharmacy Times: The Detect the SOS initiative highlights albuminuria as an early warning sign that may signal increased risk for cardiovascular events. How can identifying elevated uACR levels earlier change the trajectory of care for patients?

Wright: Albuminuria is not just a kidney issue. It is a sign of more widespread vascular problems, including issues with the heart, small vessels, and stiffening of the arteries. The heart and kidneys are interdependent, meaning that disease in one system leads to disease in the other. If we catch the elevated uACR early, we have treatment options that can effectively reduce the risk of both kidney and heart disease progression.

Pharmacy Times: When pharmacists are counseling patients with diabetes or hypertension, what key signs or clinical indicators should prompt them to initiate conversations with prescribers about uACR testing or closer kidney monitoring?

Wright: Both diabetes and high blood pressure carry an increased risk for chronic kidney disease and cardiovascular disease. Therefore, patients with either condition should be tested. Having both diabetes and hypertension increases the risk for heart and kidney disease even more than either one alone. High blood pressure is the leading cause of chronic kidney disease after diabetes. Approximately 1 in 3 adults with diabetes and 1 in 5 adults with high blood pressure may have chronic kidney disease.

People with an elevated uACR should have this confirmed by their health care professional and, in addition to lifestyle modifications, include weight loss, a good diet, increased physical activity, smoking cessation, and using their medicines as prescribed by their health care professional to control their diabetes, blood pressure, and cholesterol.

Pharmacy Times: For patients listening to this conversation during National Kidney Month, what are some practical steps they can take today to advocate for their kidney and cardiovascular health, particularly when it comes to requesting or discussing uACR testing with their provider?

Wright: People with diabetes and hypertension, people with a family history of chronic kidney disease, and people with overweight or obesity are at increased risk and should be tested for the uACR and the eGFR to assess any indication of kidney disease at least annually. I encourage patients to have a conversation with their health care professional about getting tested and knowing their risk. There are simple questions that you can ask, such as, “I’ve heard that uACR testing is indicated for people with risks like me. Can I have the test?”

Pharmacy Times: For clinicians who may already be managing multiple screenings and lab tests for patients with diabetes or hypertension, where does uACR testing fit into the broader prevention and monitoring strategy?

Wright: Again, albuminuria is not just a kidney issue. It is a sign of more widespread vascular problems and can be a very early indicator of things to come down the road. I think about the uACR as the check engine light in your vehicle. When you are driving and see that come on, your car has not failed yet, but it tells you that you need to go and get it checked to make sure that you do not have a problem further down the road.

Pharmacy Times: Beyond screening, what role do pharmacists play in managing patients who are found to have elevated albumin levels—particularly in optimizing medications, addressing cardiovascular risk factors, and supporting long-term kidney health?

Wright: Pharmacists play a critical role in cardiovascular, kidney, and metabolic management by improving medication adherence, optimizing complex therapies for patients, and conducting early screenings. Through a collaborative care model, they help comanage comorbidities like diabetes and hypertension, educate patients, and facilitate the initiation of kidney-protective therapies to slow disease progression. Some of the key roles that pharmacists can play are medication therapy management, early screening and detection, chronic disease management, and adherence and counseling. Finally, many pharmacists are now working in collaborative care models with an interdisciplinary or multidisciplinary team to help add value to the conversation for chronic kidney disease and cardiovascular disease management.