Nephrology in the Paradigm of Cardiovascular-Kidney-Metabolic Health

The "Saving Kidneys, Hearts, and Lives" workshop in March 2025, hosted by the American Society of Nephrology, brought together diverse stakeholders in the care of patients with cardiovascular-kidney-metabolic (CKM) syndrome, including multispecialty healthcare professionals, patients, and researchers from academic and community-based backgrounds. The CKM syndrome encompasses multidirectional interactions among kidney diseases, cardiovascular diseases, diabetes, and obesity. Highly efficacious therapies are now available to reduce risks of adverse kidney and cardiovascular events as well as all-cause mortality. The goal of the "Saving Kidneys, Hearts, and Lives" workshop was to gain insights and make recommendations for the role of nephrology in CKM care. Following a series of plenary talks about the current state, interactive discussions among participants focused on developing tangible strategies and opportunities for nephrology in addressing CKM syndrome. Participants noted that nephrology spans internal medicine, with special expertise in managing kidney diseases, blood pressure, and CKM risk factors along with training that emphasizes interactions among complex chronic conditions. Participants highlighted the importance of screening and implementation of CKM syndrome diagnostic and therapeutic strategies earlier than when patients have been typically referred to nephrology specialty care. Additionally, participants explored the contributions of nephrologists to upstream care, beyond their conventional focus on high-risk, rare, or advanced kidney diseases. Participants recognized barriers, including payment structures that provide relatively modest resources for complex chronic care prior to kidney replacement therapy and gaps in nephrology training to manage CKM syndrome. Ongoing strategies by the American Society of Nephrology will focus on collaborations and crossing traditional specialty boundaries of nephrology, cardiology, and metabolic diseases to promote overall CKM health.