Recognizing Kidney Function as a Key Predictor of Cardiovascular Risk

At the American Heart Association Scientific Sessions 2025 in New Orleans, Roy Matthew, MD, discusses the strong link between kidney function and cardiovascular disease, emphasizing that chronic kidney disease—or even a mild decline in kidney function—significantly increases cardiovascular risk. He notes that while this relationship has long been recognized, newer therapeutics targeting the cardiorenal metabolic syndrome are helping to shift outcomes. Matthew highlights the importance of routinely assessing both glomerular filtration rate (GFR) and albuminuria, explaining that patients with low GFR and high albuminuria face the greatest cardiovascular risk. He stresses that increasing the use of the albumin-to-creatinine ratio test in clinical practice can enhance value-based care and improve patient outcomes by allowing for better risk stratification.

Pharmacy Times: What motivated your team to explore kidney health as a determinant of cardiovascular outcomes, and what key trends did you identify across recent years?

Roy Matthew, MD: I think that there's been a lot of data over the years that have looked at the various predictors for cardiovascular disease, and what we've seen time and again is that chronic kidney disease—or any drop in kidney function—has been associated with a marked increase in cardiovascular risk. We have known about this for a long time.

The challenge has always been: what are the actual mechanisms that cause this? That has been the more difficult aspect of managing cardiovascular disease and chronic kidney disease.

In more recent years, with the newer therapeutics that have come about and really targeted the cardiorenal metabolic syndrome, this has changed the whole metric. We still see, over the years, a very high risk of cardiovascular disease among patients with chronic kidney disease or lower GFR. But I think in the next generation, in the next 10 to 20 years, we're going to see some improvement compared to prior years.

Pharmacy Times: Could you highlight the most significant findings from your analysis of CKD-related cardiovascular risk and how these may inform clinical practice?

Matthew: Yes, I think the single point that really should be emphasized in general practice is the importance of both GFR and albuminuria. The albumin-to-creatinine ratio is probably the most underordered test in clinical practice that has real clinical significance.

The chronic kidney disease community, especially the Kidney Disease: Improving Global Outcomes (KDIGO) group, has put out for many years a staging system and a heat map that emphasize both the glomerular filtration rate and albuminuria. The single finding that really represents the highest risk for cardiovascular events is found in patients with both a low GFR and a high albuminuria.

If we can increase value-based care in our patients, we can really improve outcomes because we can target risk better. It’s important to increase the ordering of the albumin-to-creatinine ratio so we can better risk stratify patients.