Cardiovascular-Kidney-Metabolic Syndrome (CKM) Has More Options Than Ever. Now What?

People living with chronic kidney disease (CKD) often have other health conditions too, like diabetes, heart disease, obesity, or heart failure. Together, these interconnected conditions are known as cardiovascular-kidney-metabolic (CKM) syndrome. The good news? Healthcare professionals have more treatment options than ever before to help protect kidney and heart health. The challenge is figuring out how to use those treatments together. Which medications should come first? Which combinations work best? And how can specialists coordinate care so patients receive clear, consistent guidance?

Combining Therapies in Kidney Disease

To help answer these questions, the National Kidney Foundation (NKF) hosted the scientific workshop Combining Therapies in Chronic Kidney Disease, which brought together people living with kidney disease and experts from across healthcare disciplines.

"We have more tools than ever before to protect kidney and heart health, but now the challenge is figuring out how to use them together in a way that makes sense for each individual," workshop leader Dr. Sankar Navaneethan said. "These discussions are essential to translating scientific advances into better care." The goal was simple–find practical ways to help people with kidney disease get the most benefit from today's treatments.

Why This Conversation Matters

Several medications now exist that are known for protecting kidney and heart health, including:

• ACE inhibitors and ARBs

• SGLT2 inhibitors

• Nonsteroidal mineralocorticoid receptor antagonists (nsMRAs)

• GLP-1 receptor agonists

These therapies are often called the "four pillars" of CKM care because they target many of the factors that increase the risk of kidney disease progression, heart disease, and other serious complications. While these medications have transformed kidney care, healthcare professionals still need guidance on how to use them together in real-world settings.

Four Key Questions That Shaped the Discussion

1. Should Treatments Start at the Same Time or One at a Time?

Some people may benefit from starting several treatments right away to lower their risk of kidney failure or heart problems. Others may need to start treatments more slowly based on their kidney function, blood pressure, side effects, medication costs, or personal preferences.

Workshop participants discussed how healthcare professionals could better balance individual patient needs. 

2. How Can Healthcare Professionals Work Better Together?

Many people with kidney disease see several healthcare professionals. Having a team can improve care, but it can also lead to problems if providers do not communicate well or give different recommendations.

“No single field owns CKM care,” workshop leader Dr. Erin Michos said. “The only way we improve outcomes is by working together to develop guidance that reflects real-world complexity and centers the patient experience.”

3. How Do We Know If Patients Are Getting High-Quality Care?

Inconsistencies in kidney care still exist. The group discussed how healthcare systems could close these gaps and provide quicker healthcare screenings, personalized medication regimens, and quality follow-up care.

“The best intervention is prevention, and effective team-based care improves patient outcomes,” Dr. Michos said. “We all need to work together to move the needle towards better kidney health.”

4. What Questions Still Need More Research?

Participants also identified areas that still need new research, including;

• Which treatment combinations work best?

• When should treatments be started?

• How can we make these therapies easier to use in everyday care?

What's Next?

This conversation doesn't end with the workshop. Workshop leaders are now reviewing the discussions, feedback, and recommendations shared during the meeting. The findings will be compiled into a comprehensive report to inform future clinical guidance, educational programs, quality improvement efforts, and research priorities. As evidence continues to evolve, NKF will work alongside healthcare professionals, researchers, patients, and partners to develop practical solutions that make it easier to deliver coordinated, patient-centered care.

**This content is provided for informational use only and is not intended as medical advice or as a substitute for the medical advice of a healthcare professional.