CKM Syndrome Stage Linked to CKD Odds, But Primary Care Hurdles Remain

Adults with more advanced cardiovascular-kidney-metabolic (CKM) syndrome had progressively higher odds of chronic kidney disease (CKD) in a national US analysis set to be presented at the American Society of Nephrology (ASN) Kidney Week 2026 in Denver, Colorado. A separate qualitative study at the meeting found that primary care clinicians see promise in the CKM framework for catching CKD earlier but question whether it holds up against current evidence and real-world workflow constraints.^1,2

The CKM concept, which was laid out in a 2023 American Heart Association (AHA) presidential advisory, describes the interplay among metabolic risk factors, CKD, and the cardiovascular system and proposes a staging system to promote prevention. Since then, the AHA, American College of Cardiology, American Diabetes Association, and ASN have released an inaugural joint guideline on CKM syndrome, and ASN has issued kidney-specific guidance calling for routine assessment of cardiovascular risk, metabolic health, and kidney function.^3,4

CKD Prevalence Climbs With CKM Stage

In the first study, investigators at Loma Linda University conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data from 2017-2018 and 2021-2023. The analysis included 5169 adults aged 18 years or older and used survey-weighted logistic regression adjusted for age, sex, and survey cycle.¹

CKD prevalence rose with higher CKM stages in both cycles. Compared with CKM stage 0, stage 2 was associated with significantly greater odds of CKD (odds ratio [OR], 1.45; 95% CI, 1.07-1.96), and stage 3 or higher showed the strongest association (OR, 2.75; 95% CI, 1.90-3.98). The researchers reported a dose-response relationship between CKM stage and CKD (P for trend < .001) that remained consistent across age groups (younger than 65 years vs 65 years and older) and by sex.¹

CKD prevalence was lower in the 2021-2023 cycle than in 2017-2018 (17% vs 21%; P < .001), and the later cycle remained associated with lower odds of CKD after multivariable adjustment (OR, 0.78; 95% CI, 0.64-0.96). The authors suggested this may reflect better risk factor management, though a cross-sectional design cannot confirm that explanation.¹

“A patient’s CKM stage can help clinicians decide how actively to look for kidney disease and how quickly to act,” Amir Abdi Pour, MD, chief of internal medicine-nephrology at Loma Linda University Health and a co-author of the study, told Pharmacy Times. “It should prompt risk-based care, rather than serve as a treatment decision on its own.”

Once patients reach stage 2, Abdi Pour said, clinicians should check both estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). “These tests should be used together because kidney risk may be evident through albuminuria even when eGFR is preserved,” he said.

Primary Care Clinicians Weigh the Framework

In the second study, researchers at the University of Virginia School of Medicine interviewed 9 primary care clinicians who spent at least half their time in ambulatory adult care. Participants watched a brief video on CKM before semistructured interviews, and the team sorted the resulting themes into strengths, weaknesses, opportunities, and threats.²

Every participant identified at least 1 strength of CKM, including its intuitive structure, simplicity, and preventive focus. Participants said that, if implemented strategically, the framework could support early CKD recognition and management and help standardize care; however, they also cited a perceived lack of evidence and uncertain value beyond existing care models, and they pointed to structural barriers, administrative burdens, and impracticality as threats to adoption.²

The investigators concluded that the framework will need a strong evidence base and must address workflow, social, and administrative barriers to be widely adopted.²

Implications for Pharmacists

ASN’s guidance identifies renin-angiotensin system inhibitors and sodium-glucose cotransporter 2 inhibitors as foundational therapies in CKD, with glucagon-like peptide-1–based therapies and nonsteroidal mineralocorticoid receptor antagonists added according to an individual patient’s cardiovascular and metabolic risk profile. It warns against therapeutic inertia and recommends integrating the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equation with kidney outcome predictors in routine counseling.⁴

“Pharmacists can help translate the AHA’s CKM framework into routine care by making kidney risk harder to overlook,” Abdi Pour said. During medication reviews or visits for diabetes, hypertension, obesity, or cardiovascular disease, he said, pharmacists can flag patients who may need kidney assessment and prompt the care team to obtain eGFR and UACR.

Once results are available, pharmacists can help identify patients who may benefit from kidney-protective treatment, review medication choice and dosing for kidney function, identify potentially harmful or interacting medicines, and support adherence and follow-up, Abdi Pour explained. Both Kidney Week findings come from conference abstracts, and the qualitative study’s sample was small.

REFERENCES

1. Tahavvori A, Ebrahimi N, Abdi Pour A. Association of cardiovascular-kidney-metabolic burden with CKD in a national US cohort. Presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO.

2. An L, Chandra K, Vincent-Johnson A, et al. Cardiovascular-kidney-metabolic syndrome integration for addressing CKD in primary care. Presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO. Abstract SA-PO0457.

3. Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148(20):1606-1635. doi:10.1161/CIR.0000000000001184

4. Navaneethan SD, Rifkin B, Mottl AK, et al. Executive summary of the ASN kidney health guidance on the cardiovascular-kidney-metabolic syndrome. J Am Soc Nephrol. 2026;37(10):2278-2281. doi:10.1681/ASN.0000001230