ASN Kidney health guidance on the cardiovascular-kidney-metabolic syndrome

People with chronic kidney disease (CKD) have an increased risk of cardiovascular disease, kidney failure and premature death, even in the early stages of CKD. This American Society of Nephrology guidance applies the cardiovascular-kidney-metabolic (CKM) syndrome framework to nephrology practice, emphasising the need to manage cardiovascular and kidney risks together rather than as separate problems.  

Sodium–glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) based therapies and nonsteroidal mineralocorticoid receptor antagonists (MRAs), used alongside Renin-Angiotensin System (RAS) inhibitors and lipid-lowering therapy, offer complementary cardiovascular and kidney benefits.  

The authors give practical advice on screening, risk stratification and treatment, highlighting the importance of serial measures of eGFR and albuminuria, alongside cardiac biomarkers and imaging where appropriate. They suggest combining the American Heart Association PREVENT equations with the Kidney Failure Risk Equation to identify high-risk patients and decide when to intensify treatment, although PREVENT is not validated in a UK population, limiting its direct applicability to UK practice, where QRISK3 is the usual standard.  

The guidance also addresses sequential and combination prescribing and the management of adverse effects. Evidence remains limited in advanced CKD, dialysis, transplant recipients, younger and older patients, and nonmetabolic diseases, such as glomerulonephritis. The authors call for coordinated multidisciplinary care that addresses CKM health together, in place of organ-specific management. 

The full article can be read here.