From Specialty Silos to Integrated Care: A Korean Initiative for Cardiovascular-Kidney-Metabolic Health

1/4Cardiovascular disease (CVD), chronic kidney disease (CKD), diabetes, obesity, and various metabolic disorders have traditionally been managed within distinct clinical and academic domains [1].However, these conditions rarely exist in isolation.They share risk factors and pathophysiological pathways, accelerate one another, and increasingly share therapeutic strategies.Beyond renin-angiotensin system inhibitors, the emergence of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists has further blurred conventional organ-based therapeutic boundaries [2].Consequently, therapies once viewed through organ-specific indications are increasingly shared across cardiology, nephrology, and endocrinology to achieve cardiovascular, kidney, and metabolic protection.The concept of cardiovascular-kidney-metabolic (CKM) syndrome provides a framework for addressing these interconnections.In 2023, the American Heart Association (AHA) formally defined CKM syndrome as a systemic disorder reflecting interactions among metabolic risk factors, CKD, and the cardiovascular system [3].More recently, the '2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome' provided the first comprehensive clinical practice guideline for CKM syndrome, transitioning the concept toward practical implementation by introducing a stage-and risk-based approach and recommending interdisciplinary care teams with a CKM coordination point person [4].This development represents an important shift from managing individual diseases toward managing the whole patient across traditional specialty boundaries.This transition is particularly relevant to Korea.