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Hormonal Regulation and Hypertension / Diabetes Treatment and Management / Chronic Kidney Disease and Diabetes · Journal article
Journal of the American Society of Nephrology · September 2, 2026
A consensus or society position rather than new primary data.
This executive summary presents professional society guidance from the AHA/ACC/ADA/ASN on integrated management of cardiovascular-kidney-metabolic syndrome, emphasizing routine risk assessment, evidence-based pharmacotherapy (RAS inhibitors, SGLT2 inhibitors, GLP-1 agonists, finerenone), and lifestyle modification in CKD. The guidance applies to general CKD populations but acknowledges limited evidence in transplant, dialysis, pediatric, and frail patients.
Journal article. Patients with chronic kidney disease (CKD), particularly those with comorbid cardiovascular and metabolic diseases; guidance notes limited evidence in transplant recipients, dialysis patients, pediatric populations, older adults, and those with frailty.
RAS inhibitors and SGLT2 inhibitors are identified as foundational therapies for prevention of cardiovascular and kidney endpoints in CKD GLP-1-based therapies and nonsteroidal mineralocorticoid receptor antagonists may be added according to individual cardiovascular and metabolic risk profile PREVENT cardiovascular risk equation should be integrated with kidney outcome predictors for routine patient counseling
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians across nephrology, cardiology, and endocrinology should adopt a coordinated, multidisciplinary approach to CKD management integrating cardiovascular and metabolic risk assessment, applying evidence-based pharmacotherapies in sequence, and avoiding therapeutic inertia. However, in populations with limited evidence (transplant, dialysis, pediatric, frail), decisions should incorporate shared decision-making.
This is an executive summary of a professional society guidance document (AHA/ACC/ADA/ASN) providing recommendations for integrated cardiovascular-kidney-metabolic syndrome management in CKD; it presents expert consensus rather than empirical trial evidence.
Clinicians across nephrology, cardiology, and endocrinology should adopt a coordinated, multidisciplinary approach to CKD management integrating cardiovascular and metabolic risk assessment, applying evidence-based pharmacotherapies in sequence, and avoiding therapeutic inertia. However, in populations with limited evidence (transplant, dialysis, pediatric, frail), decisions should incorporate shared decision-making.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
What is missing. This record has no reported figures. That is a gap in the analysis, not a judgement about the study.
KEY POINTS: The cardiovascular‑kidney‑metabolic framework encourages routine assessment of cardiovascular risk, metabolic health, and kidney function. Cardiovascular risk equations should be used in patients with CKD to direct preventive therapies and promote coordination of care to optimize outcomes. Comprehensive therapy building upon foundational CKD management is essential to minimize treatment gaps and improve cardiovascular‑kidney‑metabolic outcomes. The recent release of the inaugural AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome calls for health care professionals across disciplines to broaden their practice to include the full spectrum of these interconnected disease states. This ASN Kidney Health Guidance aims to unite the nephrology community in this effort, highlighting the central role kidney disease plays in CKM syndrome and providing CKD-specific considerations. CKD is often complicated by comorbid cardiovascular and metabolic diseases, and regular evaluation of patients should include screening and management across disease states. The Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equation should be integrated along with kidney outcome predictors for routine patient counseling and risk assessment. Lifestyle modifications, including regular physical activity, avoidance of tobacco products, and adoption of a healthy diet and sleep patterns, underpin CKM management. Both renin-angiotensin system inhibitors and sodium-glucose cotransporter 2 inhibitors are foundational therapies in CKD for the prevention of cardiovascular and kidney end points, and glucagon-like peptide-1-based therapies and nonsteroidal mineralocorticoid receptor antagonists may be added according to an individual patient's cardiovascular and metabolic risk profile. CKM therapies may be initiated simultaneously or in rapid sequence according to shared decision making, but therapeutic inertia must be avoided. Cardiovascular disease mitigation should also include lipid management for primary and secondary prevention. Evidence supporting the benefits of CKM treatments in people with glomerulonephritis, those with kidney transplant, those on dialysis with kidney failure treated with maintenance dialysis, pediatric populations, older adults, and those with frailty is limited. However, screening and diagnosis of CKM syndrome are critical, and these cardiokidney protective therapies may be used with shared decision making. Diabetes and obesity are extremely common in people living with kidney disease; both are major contributors to CKD progression. CKD poses a major risk of cardiovascular morbidity and mortality. Hence, nephrology team members should play a vital role in the diagnosis, treatment, and implementation of a holistic and multidisciplinary approach for the well-being of patients with kidney diseases.
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