The cardiovascular-kidney-metabolic staging in type 2 diabetes: the clock starts ticking early

Nishizawa et al. demonstrate that cardiovascular-kidney-metabolic (CKM) staging is a strong predictor of all-cause mortality in type 2 diabetes, even before contemporary ardiorenal therapies were widely available. In their cohort, mortality rose sharply from stage 3 onward, underscoring that pathological risk begins well before overt cardiorenal failure. Because CKM staging relies on routine clinical data, it offers a pragmatic framework for early risk stratification, yet it is often applied too late. Integrating CKM assessment into electronic health systems and initiating cardiorenalprotective interventions in stages 1-2 could substantially improve outcomes. Future studies should validate CKM staging in modern therapy settings and evaluate stageguided interventions.