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Cardio-kidney-metabolic (CKM) framework: A nephrologist's perspective
Ana Flavia Moura1, Roberto Pecoits-Filho2,3,4
1Escola Bahiana de Medicina e Saúde Pública, Departamento de Medicina Interna, Salvador, BA, Brasil.
Insights
The cardio-kidney-metabolic (CKM) framework highlights disease links but needs more kidney care evidence. Early chronic kidney disease (CKD) detection is crucial but faces challenges, especially in resource-limited settings.
Area of Science:
- Nephrology
- Cardiology
- Metabolic Diseases
- Public Health
Background:
- The cardio-kidney-metabolic (CKM) framework integrates cardiovascular, renal, and metabolic health.
- Chronic kidney disease (CKD) is often overlooked in current cardiovascular risk assessments.
- Limited application of the CKM framework in kidney care necessitates further evidence and strategic development.
Purpose of the Study:
- To provide a nephrology-focused perspective on the CKM framework.
- To emphasize the bidirectional links between CKD and cardiovascular/metabolic diseases.
- To highlight challenges in CKD detection and management within the CKM pathway.
Main Methods:
- Review of current literature and real-world data on CKM and CKD.
- Analysis of implementation gaps and outcomes in CKD management.
- Examination of challenges faced by nephrologists, particularly in low- and middle-income countries.
Main Results:
- CKD is underrecognized and receives delayed attention in the CKM pathway.
- Significant implementation gaps, suboptimal outcomes, and economic burdens are associated with delayed CKD management.
- Workforce shortages, late referrals, and fragmented care hinder nephrology practice.
Conclusions:
- The CKM framework requires a data-driven, evidence-based approach for successful implementation.
- Improved multidisciplinary coordination is essential for integrating CKD into the CKM strategy.
- Addressing challenges in early CKD detection and management is critical for optimizing CKM care.
Abstract:
The recently proposed cardio-kidney-metabolic (CKM) framework underscores the interconnected nature of cardiovascular, renal, and metabolic diseases and represents an important step toward preventive, integrated care. However, its application in kidney care remains limited and dependent on additional supportive evidence. Chronic kidney disease (CKD) is often underrecognized in cardiovascular risk models and receives delayed attention within the CKM pathway. Nephrologists face unique challenges - including workforce shortages, late referrals, and fragmented care systems - particularly in lowand middleincome countries. Early detection is further hindered by the lack of CKD-specific risk assessment tools and limited access to essential diagnostics and therapies. Real-world data from global and national studies highlight substantial implementation gaps, suboptimal outcomes, and the heavy economic burden of delayed CKD management. Importantly, as emphasized by the American Heart Association, implementation of the CKM approach is still under construction and must remain data-driven, ensuring that strategies are grounded in robust evidence. This review offers a nephrology-oriented perspective on the CKM framework, emphasizing the bidirectional relationship between CKD and other CKM components, the prognostic implications of delayed diagnosis, and the need for improved multidisciplinary coordination.
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