Cardio-kidney-metabolic (CKM) framework: A nephrologist’s perspective

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.