American Society of Nephrology (ASN) released its latest Kidney Health Guidance (KHG) on the Cardiovascular-Kidney Metabolic (CKM) Syndrome in the Journal of the American Society of Nephrology (JASN) today. The new KHG provides health care professionals with practical guidance for their role in the diagnosis and treatment of the CKM syndrome, emphasizing the interconnected relationship between metabolic risk factors such as obesity and diabetes, kidney diseases, and cardiovascular diseases.
While the recent publication of the 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney Metabolic Syndrome represents an important advance in the recognition and management of the CKM syndrome, the ASN KHG highlights the central role kidney diseases play across the four stages of CKM syndrome, including how it contributes to chronic inflammation and endothelial dysfunction, thereby increasing cardiovascular risk. The KHG emphasizes the vital role of nephrology health care professionals in the early identification and timely implementation of evidence-based therapies to improve kidney and cardiometabolic health.
With CKD present in three of the four stages of C KM syndrome, nephrology health professionals will play a significant role in coordinating and leading the care of a vast population of patients across the CKM syndrome . The Kidney Health Guidance provides an initial clinical roadmap to ensure we are diagnosing and addressing all aspects of CKM care in a coordinated and holistic manner with our cardiovascular and metabolic health colleagues.Nisha Bansal, FASN, Division of Nephrology
The ASN KHG provides a framework for kidney and cardiovascular risk assessment and strategies to manage CKD across the CKM spectrum, including:
Consideration of CKD staging and disease heterogeneity, disease progression, and risk factors (e.g., age, social determinants of health) in the diagnosis and management of CKM
Integration of healthy lifestyle behavior changes (e.g., achieving a healthy weight, avoiding tobacco use, encouraging physical activity, reducing sedentary time, getting healthy sleep, and following a low-sodium healthy dietary pattern)
Utilization of foundational and novel pharmacotherapies, including multiple therapies offering significant cardiovascular and kidney benefits, and consideration of single or combination therapies depending on patient comorbidities and long-term kidney and cardiovascular risks
Addressing special populations within kidney diseases, including individuals with advanced CKD, kidney failure requiring dialysis, kidney transplant recipients, younger and older age groups, and non metabolic etiologies like glomerular diseases.
KHG CKM Workgroup co-chair Alexander Chang, MD, MS, Professor in the Department of Nephrology at Geisinger College of Health Sciences in Danville, Pennsylvania, emphasized the importance of cardiovascular assessment in all patients with CKD and the need for shared decision-making when data to guide care are limited.
“We should be evaluating cardiovascular risk in all of those different conditions too, because patients could benefit from CKM therapies,” Chang said. “Therapies with cardiometabolic benefits may have to be used with a little bit more caution and on an individualized basis. It is important for nephrologists to assess and discuss with patients any potential benefits and risks and be candid about what uncertainties exist.”
The KHG also notes the substantial progress made with foundational and novel therapies with the potential to improve cardiovascular, kidney, and metabolic outcomes, while recognizing the persistent, significant evidence gaps that exist and highlighting critical avenues for future research.
“Recognizing the CKM syndrome as a continuum of comorbidities, with CKD at the center, will catalyze new robust research and randomized clinical trials to establish clear, cost-effective screening protocols, and validated biomarker thresholds tailored specifically to patients with kidney disease,” said Crystal Gadegbeku, MD, FASN, ASN President-Elect. “This new research must also address historically underrepresented and vulnerable populations, including individuals with advanced CKD, kidney failure requiring dialysis, kidney transplant recipients, younger and older age groups, and non-metabolic etiologies like glomerular diseases.”
(Newswise/AM)