Evaluation and management of metabolic-associated chronic kidney disease

Metabolic-associated chronic kidney disease (MACKD), defined as CKD that is caused or exacerbated by metabolic abnormalities, represents a growing global health challenge driven by insulin resistance, obesity, type 2 diabetes mellitus (T2D), hypertension, and systemic inflammation. MACKD reflects kidney damage driven by systemic metabolic dysfunction, and is not limited to diabetes- and obesity-related kidney diseases but also encompasses fatty kidney, kidney disease associated with Metabolic Associated Fatty Liver Disease (MAFLD), and the negative impacts of metabolic disease on other primary kidney diseases. As a result, management of MACKD must move beyond traditional diabetic kidney disease (DKD) paradigms and address obesity, insulin resistance, dyslipidaemia, hypertension and chronic low-grade inflammation, irrespective of diabetes status. The goals of MACKD management are to slow CKD progression, reduce cardiovascular risk, improve metabolic health and preserve functional status. Early intervention is particularly critical in South Asian populations, where metabolic risk manifests at younger ages and lower body mass index (BMI) thresholds. This review outlines a step-wise approach to the evaluation of MACKD and examines the current evidence for optimal management, taking into consideration the challenges imposed by diverse cultures, healthcare infrastructure, policies, and available resources in the South-Asian region.