Integrating Kidney Health Across the Cardio-Kidney-Metabolic Care Spectrum

Chronic kidney disease (CKD) has long been recognized as a major public health challenge, but recent scientific advances and evolving clinical frameworks have brought renewed attention to the condition. Clinicians are increasingly viewing CKD not as an isolated renal disorder but as part of a broader cardio-kidney-metabolic disease spectrum that connects kidney health with cardiovascular and metabolic risk.

During a recent clinical forum led by Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women’s Hospital, experts discussed how these shifting perspectives are reshaping CKD care. The discussion highlighted the growing role of multidisciplinary collaboration, the impact of emerging therapies that can slow disease progression, and the persistent gaps that continue to limit early diagnosis and optimal treatment.

A central theme was the recognition of CKD as part of an interconnected cardiometabolic disease network. Conditions such as diabetes, hypertension, obesity, and cardiovascular disease frequently coexist with kidney dysfunction, creating overlapping pathways that accelerate disease progression. As a result, clinicians across cardiology, endocrinology, primary care, and nephrology increasingly share responsibility for identifying and managing CKD.

Panelists noted that this broader perspective elevates the importance of kidney health within chronic disease prevention and management while underscoring the need for stronger collaboration among specialties that have traditionally worked in parallel.

Another major focus of the forum was the rapid expansion of disease-modifying therapies for CKD. In recent years, several treatment classes have demonstrated the ability to slow kidney disease progression while also reducing cardiovascular risk. These advances represent a shift from managing complications toward directly targeting mechanisms of disease progression.

Experts noted that clinical trial data supporting these therapies have been compelling, leading guidelines to increasingly recommend earlier use in appropriate patients. However, panelists acknowledged that real-world adoption has not kept pace with the evidence.

Many eligible patients with CKD still do not receive guideline-recommended therapies, reflecting a persistent gap between evidence and clinical practice. Participants pointed to several contributing factors, including the complexity of modern CKD care and the challenge clinicians face in keeping pace with rapidly evolving evidence and treatment recommendations.

Fragmented care across specialties may also contribute to inconsistent treatment patterns. Patients with CKD often receive care from multiple providers, including primary care physicians, cardiologists, endocrinologists, and nephrologists. Without clear coordination, opportunities to initiate kidney-protective therapies may be missed. Addressing these challenges will require both clinician education and health system strategies that support more consistent implementation of guideline-directed care.

Throughout the discussion, experts emphasized that improving CKD outcomes depends on identifying the disease earlier. Because CKD often progresses silently, many patients remain undiagnosed until kidney function has declined substantially.

Routine laboratory testing, including estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), can help clinicians identify patients earlier and assess risk more effectively. Early detection also allows for more aggressive management of underlying drivers such as diabetes and hypertension.

As therapeutic options expand, earlier diagnosis may play an increasingly important role in altering the long-term trajectory of kidney disease.

Looking ahead, participants agreed that improving outcomes will require a more integrated approach to CKD care. No single specialty can address the full complexity of cardio-kidney-metabolic disease alone.

Instead, effective management will depend on collaboration across primary care, cardiology, endocrinology, and nephrology to identify at-risk patients earlier, coordinate treatment strategies, and ensure consistent use of kidney-protective therapies.

The discussion ultimately highlighted a key inflection point for CKD care. Scientific advances have created new opportunities to slow disease progression and reduce complications, but realizing those benefits will require closing persistent gaps in awareness, screening, and treatment.

References

1. US Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. May 15, 2024. Accessed March 13, 2026. https://www.cdc.gov/kidney-disease/php/data-research/index.html

2. American Kidney Fund. Risk factors for kidney disease. Accessed March 13, 2026. https://www.kidneyfund.org/all-about-kidneys/risk-factors