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September 2, 2026Journal of the American Society of Nephrology

ASN Kidney Health Guidance on the Cardiovascular-Kidney-Metabolic Syndrome

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Why the study?

Important gaps remain in applying the cardiovascular-kidney-metabolic framework to patients with kidney diseases, especially in advanced CKD, dialysis, transplant recipients, and nonmetabolic kidney diseases.

Design

Clinical guidance document

Key result

The Ontario Renal Network outlines best practices for Multi-Care Kidney Clinics to provide person-centered, multidisciplinary care for patients with advanced chronic kidney disease.

Discussion

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Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

ACAlexander ChangProfessor of Nephrology, Geisinger College of Health Sciences

“We should be evaluating cardiovascular risk in all of those different conditions too, because patients could benefit from CKM therapies. Therapies with cardiometabolic benefits may have to be used with a little bit more caution and on an individualized basis. It is important for nephrologists to assess and discuss with patients any potential benefits and risks and be candid about what uncertainties exist.”

Geisinger College of Health SciencesNews Coverage
NBNisha BansalNephrologist, University of Washington

“With CKD present in three of the four stages of CKM syndrome, nephrology health professionals will play a significant role in coordinating and leading the care of a vast population of patients across the CKM syndrome. The Kidney Health Guidance provides an initial clinical roadmap to ensure we are diagnosing and addressing all aspects of CKM care in a coordinated and holistic manner with our cardiovascular and metabolic health colleagues.”

University of WashingtonNews Coverage

Overview

Integrates PREVENT/KFRE stratification and combination SGLT2i/GLP-1/MRA/RASi into CKD practice; establishes new direction by translating recent trials into multidisciplinary guidance.

Structured PICO

P
Population
Patients with advanced chronic kidney disease at high risk of progressing to end-stage kidney disease, eligible for multi-care kidney clinic enrollment.
I
Intervention
Implementation of the cardiovascular-kidney-metabolic (CKM) syndrome framework, including screening, risk stratification (PREVENT and KFRE equations), and pharmacologic management (SGLT2 inhibitors, GLP-1 therapies, nsMRAs, RAS inhibitors, lipid-lowering therapies).

The ASN Kidney Health Guidance outlines a holistic, multidisciplinary approach to managing cardiovascular-kidney-metabolic syndrome in patients with kidney diseases to reduce cardiovascular events and slow kidney disease progression.

Limitations

  • Important gaps remain in applying the CKM framework to patients with advanced CKD, kidney failure treated with dialysis, kidney transplant recipients, younger and older individuals, and those with nonmetabolic kidney diseases including glomerular disorders.

Cite This Study

A 2026 study studied Advanced chronic kidney disease. Multi-Care Kidney Clinic (MCKC) care was evaluated. The Ontario Renal Network outlines best practices for Multi-Care Kidney Clinics to provide person-centered, multidisciplinary care for patients with advanced chronic kidney disease.

synapsesocial.com/papers/6a9a4fc0f9da1bc1819e508fhttps://doi.org/10.1681/asn.0000001231
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