Connecting the dots in cardio-kidney-metabolic
New guideline emphasizes interdisciplinary approach for multi-organ patient care.
As guidelines across myriad medical specialties expand and evolve, more are encouraging an integrative approach to patient screening. That’s the case for the 2026 cardiovascular-kidney-metabolic (CKM) syndrome guideline, jointly developed by the American Heart Association, the American College of Cardiology, the American Diabetes Association and the American Society of Nephrology.
Designed to provide guidance for managing some of the nation’s most common and interconnected chronic diseases, the guideline is the foundation for the Sunday session “Bringing the AHA/ACC/ADA/ASN Cardiovascular-Kidney-Metabolic Syndrome Guideline to Life.” At the session, Janani Rangaswami, MD, FAHA, FACP, will present “Saving Kidneys, Hearts and Lives: Best Practices for CKD Management in CKM Syndrome.”
“One of the big elements of guideline framework is emphasizing that metabolic factors like obesity and diabetes, kidney diseases and cardiovascular disease are deeply interconnected,” said Rangaswami, a professor of medicine at the George Washington University School of Medicine & Health Sciences in Washington, D.C., and past chair of the Council on the Kidney in Cardiovascular Disease of the American Heart Association. “We have this big opportunity to screen for kidney disease, which is a central piece of the CKM syndrome construct, and to implement foundational therapies with cardioprotective benefits that also have kidney protective benefits.”
The guideline — which expands upon the Heart Association’s 2023 Presidential Advisory on CKM syndrome, for which Rangaswami served as vice chair — underscores the importance of identifying patients earlier and intervening before adverse cardiovascular and kidney complications occur.
Many therapies that protect the heart, including incretin-class therapies and SGLT2 inhibitors, also benefit other organs, creating an opportunity to improve outcomes across several organ systems, Rangaswami said.
A cornerstone of the new guideline, released in June, is a five-stage classification system that categorizes patients from stage 0, indicating no CKM syndrome, through stage 4, which represents established cardiovascular disease. Intermediate stages capture obesity, cardiometabolic risk factors such as diabetes and hypertension, kidney disease and subclinical cardiovascular disease, she said. During the session, she will focus on the central role of kidney health for people living with CKM syndrome.
“Kidney disease is largely asymptomatic, and even if people have it, 90% of individuals don’t even know they have it. But it’s very easy to diagnose using blood tests and urine tests,” Rangaswami said. “Once kidney disease is detected, it is a powerful amplifier for cardiovascular disease risk. The guideline and the CKM framework offer a lot of granular guidance on how to institute appropriate cardio-kidney therapies that will reduce adverse cardiovascular disease outcomes and protect kidney function in a risk-appropriate and equitable fashion.”
The guideline identifies obesity as a major upstream contributor to the development of diabetes, hypertension, metabolic liver disease, kidney disease and heart disease. As a result, it advocates personalized obesity management strategies that begin with nutrition and lifestyle interventions, along with pharmacotherapies and, when appropriate, metabolic or bariatric surgery, Rangaswami said.
She notes the Heart Association’s PREVENT™ cardiovascular risk calculator as an important tool to estimate a person’s risk of cardiovascular disease over 10- and 30-year horizons. PREVENT incorporates cardiovascular, kidney, metabolic and social health measures to generate more personalized risk estimates to complement the CKM staging system and allows for more nuanced shared decision-making between clinicians and patients when considering CKM therapies.
Beyond clinical care, Rangaswami said the guideline stresses the impact of social drivers of health. Patients with CKM syndrome frequently face barriers including limited healthcare access, medication affordability challenges, low health literacy and systemic inequities, she said.
“A large part of treating CKM syndrome optimally is not just screening for disease and implementing cardio-kidney protective medications, but to simultaneously screen for adverse social determinants of health and to help close some of those gaps so that we can holistically and equitably improve outcomes,”
she said.
Finally, Rangaswami underscored the guideline’s interdisciplinary effort to spotlight the need for a team-based approach to care.
“Patients are walking around with all these interconnected conditions, but they don’t primarily belong to any one specialty,” she said. “Right now, we have this fragmented health system where patients don’t know who their quarterback is. They have a primary care clinician who refers them to specialty care as needed, and usually when organ damage is established,” especially in nephrology.
“But there’s not much cross talk between all these moving parts, and patients are left in the middle navigating a complex system with complex interconnected conditions. Everybody has a stake in the game. So, the call to action is for each of these specialties to move toward a team-based approach, to effectively screen and treat individuals with CKM syndrome to save kidneys, hearts and lives.”
