Reading CKM Signals Together, Not in Isolation

In an interview with Pharmacy Times, Andrew Bzowyckyj, PharmD, BCPS, CDCES, FADCES, FAPhA, FCCP, senior scientific director and learning consultant at the National Kidney Foundation, discussed how pharmacists can use the cardiovascular-kidney-metabolic (CKM) syndrome framework to evaluate patients through a more comprehensive lens.

Drawing on a presentation he co-delivered at the 2026 Association of Diabetes Care and Education Specialists (ADCES) Annual Meeting in Columbus, Ohio, titled “Decoding CKM Through Three Key Signals: Kidney, Heart, and Inflammation,” Bzowyckyj explained that diabetes, obesity, hypertension, chronic kidney disease (CKD), heart failure, and metabolic liver disease all influence and magnify one another, and that reading signals such as albuminuria, ejection fraction, and inflammation together—rather than in isolation—is essential for accurate risk stratification. That comprehensive view, he said, supports treatment decisions that are patient-specific rather than one-size-fits-all and helps clinicians replace an A1C-focused model with a more risk-based one that guides dose titration, added agents, and lifestyle intervention.

Bzowyckyj identified the urine albumin-to-creatinine ratio (UACR) as the signal most often overlooked in practice. He noted that approximately 20% of patients with diabetes or hypertension have this testing done, leaving the majority of people living with kidney disease untested, in part because the process is asymptomatic. Guidelines now recommend annual UACR testing in patients with diabetes and, under newer hypertension guidance, in patients with hypertension as well, with heart failure emerging as an additional area of value given UACR’s role as a driver of worse outcomes. By contrast, ejection fraction more often appears in the chart because heart failure tends to become symptomatic earlier and prompts hospitalization and testing. High-sensitivity C-reactive protein, the third signal, remains an emerging tool reserved for risk stratification in clinically ambiguous situations. For pharmacists, the practical message is to help close the UACR testing gap in high-risk patients.