Cardiovascular–Kidney–Metabolic (CKM) Syndrome: An Integrated Framework for Prevention, Clinical Management, and Nursing Practice

Abstract

Cardiovascular–kidney–metabolic (CKM) syndrome is an integrated clinical framework describing the interdependence of metabolic risk factors, chronic kidney disease (CKD), and cardiovascular disease (CVD). Conditions such as obesity, insulin resistance, diabetes, hypertension, and dyslipidaemia may contribute to kidney and vascular injury, while kidney dysfunction can further increase cardiovascular risk. This narrative review summarizes the concept, components, pathophysiology, staging, assessment, prevention, management, and nursing implications of CKM syndrome. The review draws on the American Heart Association’s 2023 scientific statements, the 2026 multisociety CKM guideline, kidney and diabetes guidance, and relevant clinical literature. The framework describes a continuum from Stage 0, with no identified CKM risk factors, to Stage 4, with clinical cardiovascular disease. Assessment may include anthropometric measures, blood pressure, glucose and lipid testing, estimated glomerular filtration rate, urine albumin, and cardiovascular investigations when indicated. Management is individualized and may combine healthy dietary patterns, appropriate physical activity, weight management, tobacco avoidance, control of blood pressure and lipids, diabetes and kidney-directed therapies, and disease-specific cardiovascular treatment. Nursing practice contributes through screening, education, medication-adherence support, monitoring, early recognition of deterioration, and coordination of care. CKM syndrome encourages a shift from fragmented management of separate diagnoses to prevention and treatment that consider cardiovascular, kidney, and metabolic health together. Evidence remains dependent on the underlying conditions and evolving guidance; clinical decisions require individual assessment.