When patients think about cardiovascular risk, they often focus on cholesterol, blood pressure, blood sugar, or coronary artery calcium. But routine kidney markers like eGFR, creatinine, and uric acid can also provide powerful insight into future cardiovascular risk.
Reduced eGFR, elevated creatinine, and elevated uric acid are each associated with higher rates of cardiovascular events and mortality, even after accounting for traditional risk factors (Grams et al., 2023).
The reason is simple: the heart and kidneys are deeply connected. The kidneys regulate blood pressure, fluid balance, sodium handling, and vascular tone. When kidney function declines, even modestly, the body shifts toward endothelial dysfunction, inflammation, oxidative stress, and neurohormonal activation. These changes accelerate atherosclerosis, heart failure risk, and cardiovascular mortality (Ndumele et al., 2023; Gansevoort et al., 2013).
In other words, kidney function is not just a kidney issue—it is a core part of cardiovascular risk assessment.
Why Kidney Markers Predict Cardiovascular Risk
Kidney markers act as both early warning signs and, in some cases, contributors to disease.
Reduced eGFR reflects impaired filtration and may play a causal role in cardiovascular disease. Creatinine is best viewed as a marker of kidney function rather than a direct toxin. Uric acid appears biologically active and may contribute to endothelial dysfunction, oxidative stress, inflammation, and insulin resistance, although causality is still debated (Gaziano et al., 2022; Ndrepepa, 2018).
eGFR and Cardiovascular Disease Risk
eGFR is one of the strongest kidney-related predictors of cardiovascular outcomes.
A meta-analysis of more than 27 million adults showed that lower eGFR is associated with higher risk of cardiovascular mortality, hospitalization, kidney failure, and all-cause mortality. Importantly, risk increases progressively as eGFR declines, not just after crossing a chronic kidney disease threshold (Grams et al., 2023).
Even mild reductions in kidney function matter. Studies show that early or borderline declines in eGFR are associated with higher cardiovascular risk, especially when combined with other cardiometabolic risk factors (Hussain et al., 2023; Chan et al., 2024).
Creatinine and Cardiovascular Risk
Creatinine is less precise than eGFR because it is influenced by muscle mass, age, and sex. However, higher creatinine levels are still associated with worse cardiovascular outcomes.
In long-term population studies, elevated creatinine has been linked to higher risk of myocardial infarction, ischemic heart disease, and early death (Sibilitz et al., 2014).
Clinically, creatinine should always be interpreted alongside eGFR and, ideally, urine albumin testing. A mildly elevated creatinine may still signal meaningful cardiovascular risk depending on context.
Uric Acid and Cardiovascular Risk
Uric acid is commonly associated with gout, but it also plays a role in cardiovascular health.
Higher uric acid levels are associated with increased cardiovascular risk in a graded fashion. Even levels between 5.0–6.0 mg/dL show increased risk compared to lower ranges, with higher levels associated with progressively greater risk (Kim et al., 2023).
Mechanistically, uric acid may promote oxidative stress, reduce nitric oxide availability, impair endothelial function, and worsen insulin resistance (Yu and Cheng, 2020; Borghi et al., 2020).
From a practical standpoint, elevated uric acid often reflects dietary patterns that also increase cardiovascular risk.
How Kidney Dysfunction Drives Heart Disease
Kidney dysfunction contributes to cardiovascular disease through several key pathways:
- Endothelial dysfunction
- Chronic inflammation and oxidative stress
- Activation of the renin-angiotensin-aldosterone system
- Increased vascular stiffness and blood pressure
These mechanisms promote atherosclerosis, left ventricular hypertrophy, and heart failure (Sarnak et al., 2019; Ndumele et al., 2023).
The PREVENT Risk Calculator and eGFR
The American Heart Association’s PREVENT equations now include eGFR as a core variable in cardiovascular risk prediction.
This reflects a major shift in how kidney function is viewed. Earlier models often underestimated risk in patients with reduced kidney function. PREVENT improves risk prediction by incorporating cardiovascular-kidney-metabolic health (Khan et al., 2024).
Nutrition Strategies for Patients with Kidney and Cardiovascular Risk
For most patients, the goal is not an immediate restrictive renal diet. Instead, start with a cardiometabolic, plant-forward dietary pattern.
Mediterranean or DASH-style pattern
Emphasize vegetables, fruits, legumes, whole grains, nuts, seeds, olive oil, and fish while limiting ultraprocessed foods (Lichtenstein et al., 2021).
Sodium reduction
Reducing sodium intake, especially from processed foods, remains one of the most effective interventions for blood pressure and kidney health.
Protein moderation
Avoid excessive protein intake, particularly from animal sources, and shift toward more plant-based protein.
Maintain potassium-rich whole foods when appropriate
Most patients benefit from maintaining fruit and vegetable intake unless hyperkalemia is present.
Limit ultraprocessed foods and phosphorus additives
Reducing ultraprocessed foods improves both kidney and cardiovascular outcomes.
Target uric acid through diet
Reduce alcohol, sugar-sweetened beverages, and high-purine meats while emphasizing fiber-rich foods.
Bottom Line
Reduced eGFR, elevated creatinine, and elevated uric acid are all associated with increased cardiovascular risk.
eGFR is one of the strongest predictors and is now included in modern risk tools like PREVENT. From a nutrition standpoint, the most effective strategy is a plant-forward, minimally processed dietary pattern with targeted adjustments based on kidney function.
About the Author
Joseph Lehrberg, MS, RD is a registered dietitian specializing in cardiovascular and metabolic health and founder of CardioFunction Integrative Nutrition Services, a nutrition practice based in Boston. He works with patients with elevated cholesterol, high coronary artery calcium scores, high triglycerides, statin intolerance, and other cardiometabolic risk factors to develop evidence-based nutrition strategies for long-term heart health.
Learn more about working with him here.
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