February is National Heart Month, which offers an important opportunity to revisit a well-established but often underappreciated reality in population health: the link between chronic kidney disease (CKD) and cardiovascular disease (CVD).
Kidney disease and cardiovascular disease are deeply interconnected. When kidney function declines, the heart is often compromised, increasing a patient’s risk of CVD. Together, CKD and CVD drive morbidity, mortality, and healthcare costs.
“Importantly, these conditions need to be thought about collectively because that's how patients experience them,” said Mariell Jessup, MD, FAHA, chief science and medical officer of the American Heart Association, in a 2025 article.1
For providers and payer organizations, understanding the bidirectional relationship between cardiovascular health and kidney disease outcomes and delivering a coordinated, whole-person approach to care is essential to improving outcomes across complex populations.
Cardiovascular Disease: The Leading Cause of Death in CKD
A number of studies, including an article2 published in the American Heart Association journal CIRCULATION, identify cardiovascular disease as the leading cause of death in chronic kidney disease populations. Even patients with early-stage CKD face a significantly higher risk of heart attack, stroke, and heart failure compared to individuals without kidney disease.
This elevated risk frequently appears long before patients progress to kidney failure, making early identification and intervention a critical priority for both clinicians and payers. From a population health standpoint, unmanaged cardiorenal syndrome represents not only a clinical challenge, but a missed opportunity for prevention.
High-level evidence from organizations such as the Centers for Disease Control and Prevention and the National Kidney Foundation consistently demonstrates the disproportionate cardiovascular burden borne by individuals with CKD.
Why Kidney Health Is Central to Heart Health
CKD and CVD share many of the same risk factors, including hypertension, diabetes, obesity, and advancing age. However, their relationship goes well beyond a common risk.
As kidney function declines, cardiovascular risk rises sharply. Impaired kidneys struggle to regulate blood pressure, fluid balance, and key hormones that affect vascular health. Over time, this accelerates atherosclerosis, increases cardiac workload, and contributes to structural and functional heart changes.
Conversely, heart disease (particularly heart failure) can reduce kidney perfusion, worsening kidney function and accelerating disease progression. The result is a reinforcing cycle in which dysfunction in one organ directly contributes to deterioration in the other.
Understanding Cardiorenal Syndrome
The concept of cardiorenal syndrome provides a useful framework for understanding this bidirectional relationship. Broadly defined, cardiorenal syndrome describes conditions in which acute or chronic dysfunction of the heart or kidneys induces dysfunction in the other organ.
From a medical management perspective, this means that treating heart disease without accounting for kidney health or managing CKD without addressing cardiovascular risk leaves patients vulnerable to avoidable complications. It also underscores why siloed care models often fall short for complex, high-risk populations.
Joel Forman, MD, a practicing cardiologist and member of Healthmap Solutions’ Scientific Advisory Board, offers a deeper dive into the need for a multidisciplinary care management strategy for kidney patients in Healthmap’s white paper, “Managing Cardiovascular Health In Patients with Kidney Disease: A Comprehensive Approach.”
The Cost Implications
For payer organizations, the cardiorenal connection has direct and measurable financial consequences. Individuals with both CKD and CVD experience higher rates of hospitalization/readmission and increased emergency department utilization.
These and other dynamics significantly increase total cost of care and complicate performance under value-based arrangements. Importantly, many of these costs are driven not by late-stage disease alone, but by years of suboptimal risk identification and fragmented management earlier in the disease course.
The Critical Role of Primary Care and Early Identification
Primary Care Providers (PCPs) are uniquely positioned to address the cardiorenal cycle early and prevent adverse outcomes. Routine monitoring of blood pressure, blood glucose, and kidney function allows clinicians to identify early kidney disease and cardiovascular risk before complications emerge.
For payers, supporting primary care engagement in early CKD detection and management is critical. Early identification enables proactive interventions that can slow disease progression, reduce cardiovascular events, and avoid costly downstream acute care utilization.
Coordinated Care: Aligning Kidney and Heart Health
When kidney health is addressed as part of a broader cardiovascular strategy, payers and providers can achieve more impactful improvements in outcomes while stabilizing costs.
Again quoting the AHA’s Dr. Jessup, “A holistic approach to care helps deliver better treatment and reduce the sense of overwhelm patients report about managing multiple chronic health conditions.”
Addressing the cardiorenal connection effectively requires coordinated care models that integrate kidney and cardiovascular risk management. Key elements include:
- Population-level identification of at-risk members
- Ongoing monitoring of clinical markers tied to both kidney and heart health
- Structured outreach and education to support treatment adherence and self-management that addresses both conditions
- Alignment across primary care, nephrology, and cardiology when appropriate
The Cardiorenal Connection in Population Health Strategy
It should be clear that kidney disease and cardiovascular disease are inseparable challenges. Addressing them together, through early identification, coordinated care, and population-level strategies offers an effective path to better outcomes and sustainable cost control.
Healthmap Solutions supports managing cardiovascular disease as a core comorbidity for members in our integrated, multidisciplinary Kidney Population Health Management program. By identifying CKD early and coordinating care management with PCPs, we help address the cardiorenal factors that drive disease progression, hospitalizations, and cost, leading to measurably better outcomes.
References
1 https://newsroom.heart.org/news/rise-in-kidney-disease-underscores-critical-heart-kidney-connection/
2 www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050686/
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