Background: The prevalence and burden of chronic kidney disease (CKD) is increasing. Despite available early detection methods, many individuals with CKD remain undiagnosed. We evaluate the effectiveness of albuminuria screening for early detection and management of CKD in the primary care setting. Methods: We conducted a cross-sectional, multicenter epidemiological study in primary care centers in the province of Burgos, Spain, from February to May 2024. The urinary albumin:creatinine ratio (uACR) was assessed in 9890 adults attending primary care visits. The primary finding was the prevalence of CKD defined by KDIGO guidelines thresholds for albuminuria and estimated glomerular filtration rate (eGFR), stratified by age, gender and motive for consultation. Results: In total, 22.29% of participants met CKD criteria, with 14.04% showing uACR levels above 30 mg/g (albuminuria categories A2–A3) and 12.81% displaying reduced eGFR levels (categories G3–G5). Albuminuria screening identified CKD in 1338 (14.1%) participants, including 903 (10.88%) individuals with eGFR >60 mL/min/1.73 m² and 434 (35.57%) participants with CKD upgraded to higher risk due to albuminuria. Among individuals with CKD, 2123 (22.29%) participants were eligible for therapies to slow disease progression, per current KDIGO guidelines. Conclusion: The ONDAAS study reveals a high prevalence of CKD among individuals attending primary care facilities, emphasizing the importance of albuminuria screening for early detection and risk stratification of CKD. Our findings demonstrate how early screening can significantly shape therapeutic choices and ultimately enhance patient care outcomes.

Population aging has shifted the burden of cardiovascular disease toward older adults living with multimorbidity, frailty, cognitive vulnerability, functional impairment, and treatment burden. Yet much of the contemporary cardiovascular evidence still derives from randomized clinical trials (RCTs) designed around biologically homogeneous participants, limiting applicability to real-world geriatric cardiology. Our objective was to perform a comparative methodological analysis of two contemporary European cardiovascular RCTs, HI-COR-65 and SENEKA, as illustrative cases and to propose a geriatric-oriented framework for improving trial design in older adults with cardiovascular multimorbidity. We qualitatively compared both trials across five domains: population representativeness, clinical objectives and outcome hierarchy, exclusion criteria, multidisciplinarity, and patient perspective, including participation burden and patient-reported outcomes. Both trials represent important progress by explicitly enrolling older adults with clinically relevant cardiovascular multimorbidity. However, the analysis identified recurring limitations: geriatric complexity is acknowledged but not operationalized through comprehensive geriatric assessment or vulnerability-based stratification; safety and participation requirements may preferentially select robust older adults; outcome hierarchies remain variably aligned with patient priorities; and intervention models are predominantly pharmacological and monodisciplinary. Future cardiovascular trials in older adults should move from chronological inclusion toward pragmatic, complexity-sensitive design. We propose the Comprehensive Geriatric Cardiology (COMGERCARDIO) framework, which integrates baseline geriatric assessment, vulnerability-adaptive interventions, hierarchical patient-centered outcomes, stratified analysis, and implementation evaluation to generate evidence that is scientifically robust, clinically usable, and equitable for aging populations.