The American Heart Association's 2023 recognition of cardiovascular-kidney-metabolic (CKM) syndrome named something nephrologists already saw daily: chronic kidney disease, obesity, diabetes, hypertension, dyslipidaemia and cardiovascular disease as one problem rather than six. The practical question it raised was whether a new guideline was needed. This review's answer is no — the guidance exists, distributed across documents.
It maps the existing KDIGO output onto the syndrome: the chronic kidney disease guideline, the blood pressure guideline, the diabetes-in-CKD guideline, the lipid guideline, a forthcoming guideline on heart failure in chronic kidney disease, and controversies conference reports on obesity and on prevention of kidney disease. The themes that recur across them are consistent — detect early, manage kidney and cardiovascular risk together and personally rather than sequentially, and work across disciplines.
What this changes is how a clinic runs rather than what is prescribed. A patient whose albuminuria, blood pressure, HbA1c, lipids and weight are each managed by a different clinician against a different guideline is receiving CKM care in name only. The actionable step is to make one consultation cover all of them, with an explicit list, rather than assuming the cardiologist is handling the lipids and the diabetologist the weight.
- Review albuminuria, blood pressure, glycaemia, lipids and weight in the same consultation, against one problem list
- Name explicitly which clinician owns each target rather than assuming
- Treat early detection as the intervention: the guidance repeatedly returns to it
- Read the KDIGO documents as one framework rather than four separate guidelines
- Note that a heart failure in CKD guideline is stated as forthcoming
Why it matters
It removes the excuse that CKM syndrome needs new guidance before care can be organised around it.
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