The American Society of Nephrology (ASN) has published new kidney health guidance on cardiovascular-kidney-metabolic (CKM) syndrome in the Journal of the American Society of Nephrology, designed to complement the landmark joint guideline issued earlier in 2026 by the AHA, ACC, ADA, and ASN. The guidance zeroes in on the nephrologist's unique role, emphasizing that CKD itself should be treated as a major CKM risk factor and that cardiovascular and kidney risk must be assessed together.

Rather than adding new clinic visits, the workgroup encourages integrating CKM assessments — including eGFR, urine albumin-creatinine ratio, blood pressure, BMI, HbA1c, and lipid profiles — into existing routine care. Foundational therapies like RAS inhibitors and SGLT2 inhibitors are recommended, with GLP-1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists as additional options for eligible patients. Lifestyle modifications, including physical activity, healthy diet, and tobacco avoidance, round out the management approach.

Key Takeaways:

• CKD should be viewed as a major CKM risk factor — CV and kidney risk must be assessed together
• Use the CVD PREVENT equation and Kidney Failure Risk Equations alongside routine kidney assessments
• SGLT2 inhibitors and RAS inhibitors are first-line; expect initial eGFR dips with SGLT2 inhibitors — don't discontinue
• GLP-1 receptor agonists are recommended for CKD patients with obesity or type 2 diabetes already on dual therapy
• More research is needed in underrepresented groups: dialysis patients, transplant recipients, children, and older adults

Why it matters: CKM syndrome affects millions, yet kidney disease patients are often underrepresented in clinical trials. This guidance gives nephrologists a practical, integrated roadmap to close treatment gaps and coordinate care across cardiology, endocrinology, and beyond — potentially slowing disease progression and improving outcomes for high-risk patients.