🔎︎
The American College of Cardiology, American Heart Association, American Diabetes Association, and American Society of Nephrology published the first clinical practice guideline for cardiovascular-kidney-metabolic (CKM) syndrome on June 9, 2026, in the Journal of the American College of Cardiology and Circulation. The guideline, chaired by Chiadi E. Ndumele, addresses the prevention, detection, evaluation, and management of CKM syndrome, an interrelated condition involving metabolic risk factors, chronic kidney disease, and cardiovascular disease. It retires, replaces, and expands on the 2013 guideline for the management of overweight and obesity in adults.
A central feature of the guideline is a staging framework for CKM syndrome. The stages range from early risk factors to established cardiovascular disease, with the most advanced stage categorized by the absence or presence of kidney failure. The guideline also incorporates kidney and metabolic measures into cardiovascular risk estimation through the PREVENT equations, which assess 10- and 30-year risk and include outcomes such as heart failure and total cardiovascular disease. For health plans, the staging framework may support risk stratification, registry development, and allocation of care management resources based on disease severity and progression risk.
The guideline includes treatment recommendations for therapies with cardiovascular, kidney, and metabolic effects, including SGLT2 inhibitors, GLP-1 receptor agonists, renin-angiotensin system inhibitors, and nonsteroidal mineralocorticoid receptor antagonists. It also identifies metabolic and bariatric surgery as an option for appropriate patients. These recommendations may have implications for formulary placement, prior authorization, and coverage policies, particularly for drug classes used across diabetes, obesity, kidney disease, and cardiovascular disease. Plans may evaluate these therapies in relation to their effects across multiple organ systems rather than within a single disease category.
The guideline also emphasizes interdisciplinary care and includes screening for social factors that affect health, such as food insecurity, housing instability, and financial strain. These recommendations may be relevant to value-based contracting, quality measurement, and care coordination programs. The writing committee describes the guideline as a living document and notes evidence gaps, including questions about the implementation of new risk assessment tools and the effect of integrated care models on outcomes.
