KDIGO has published a new commentary in Kidney International describing how published KDIGO Guidelines and Controversies Conference reports collectively provide guidance on care across the cardiovascular-kidney-metabolic (CKM) spectrum.
Framed around the need for a more integrated, patient-centered approach to identifying risk and managing CKM-related conditions, the commentary brings together and delineates KDIGO guidance on chronic kidney disease (CKD), blood pressure, diabetes, lipids, obesity, CKD prevention, and heart failure in CKD.
“The CKM framework has sharpened attention on the related pathophysiology between kidney, cardiovascular, and metabolic diseases, while also highlighting the need for more precise identification and assessment of kidney disease within that broader picture,” said Paul Stevens, MB (United Kingdom), KDIGO 2024 CKD Guideline Co-Chair. “CKD is a powerful amplifier of cardiovascular risk, yet it often remains under-detected even in people known to be at high risk. Earlier recognition of kidney disease, including routine albuminuria testing and accurate staging, is essential to improving outcomes.”
The commentary underscores the close relationship between CKD and heart failure, two conditions that frequently coexist and complicate one another in practice.
“Heart failure and CKD frequently coexist, share underlying mechanisms, and are too often undertreated when considered in isolation,” said Nisha Bansal, MD (United States), Co-Chair of the KDIGO Heart Failure in CKD Guideline, which is in the process of being developed. “Improving outcomes requires coordinated care that takes both conditions into account, from recognizing heart failure in people with CKD to applying therapies that reduce cardiovascular risk, slow kidney disease progression, and support both heart and kidney health.”
The commentary also points to therapies and care strategies that can deliver benefit across CKM, including renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, as well as lifestyle interventions and team-based care.
“Diabetes is one of the clearest examples of how CKM risk converges in clinical practice,” said Ian de Boer, MD (United States), KDIGO 2022 Diabetes and CKD Guideline Co-Chair. “Increasingly, we have therapies that can address those overlapping risks at the same time, creating an opportunity to reduce cardiovascular risk and slow kidney disease progression in people with diabetes and CKD. Recognizing CKM risks earlier helps to better align care across conditions rather than treating each in isolation.”