Assessment and management of cardiovascular-kidney-liver metabolic-syndrome in the primary care setting: A...

The recently introduced cardiovascular-kidney-metabolic (CKM) syndrome captures the close interplay between metabolic risk factors, chronic kidney disease, and cardiovascular disease, but insufficiently reflects the important additional role of the liver. Metabolic dysfunction-associated steatotic liver disease (MASLD), the most prevalent chronic liver disease worldwide, is strongly associated with cardiovascular events, kidney disease progression, and all-cause mortality, yet remains frequently under-recognized in routine clinical practice. We propose the concept of a cardiovascular-kidney-liver-metabolic syndrome (CKLMS) and present a multidisciplinary, primary care-centered framework for its assessment and management. Based on expert consensus and current evidence, the framework integrates cardiovascular, renal, hepatic, and metabolic risk stratification using accessible, validated tools feasible in primary care, including blood pressure and lipid profiling, assessment of kidney function and albuminuria, non-invasive liver fibrosis testing, and systematic screening for diabetes and obesity. Management emphasizes early lifestyle intervention, use of pharmacological therapies with multi-organ benefit, and clearly defined referral pathways to specialist care. Primary care professionals are positioned as coordinators of longitudinal, patient-centered, multidisciplinary management. Early, integrated identification and treatment of CKLMS in primary care represents a pragmatic and effective strategy to prevent disease progression, reduce cardiovascular and kidney events, and improve long-term outcomes.