Cardiovascular-kidney-metabolic (CKM) syndrome.

Cardiovascular-kidney-metabolic (CKM) syndrome recognises the connection between metabolic conditions (particularly obesity, diabetes and metabolic dysfunction-associated fatty liver disease), chronic kidney disease and cardiovascular disease. There is a high and growing prevalence of CKM syndrome. While genetic and epigenetic factors predispose to CKM syndrome, the emergence of disease is heavily influenced by social determinants of health and individual behaviours. The pathophysiology of CKM syndrome is driven by insulin resistance, inflammation, oxidative stress and vascular dysfunction. Urinary albumin:creatinine ratio is a relatively cheap and accessible biomarker of CKM syndrome, which can be used to identify and monitor disease trajectory. Primary and secondary prevention is relevant across the life course. Healthy behaviours, including diet, physical activity, sleep and stress management are important. There are established and emerging drugs that are effective across a range of metabolic conditions and that confer reno- and cardio-protective effects. Remission may be achievable.