Cardiovascular kidney metabolic syndrome from pathophysiological interaction to integrated clinical management

Cardiovascular kidney metabolic syndrome provides an integrated framework for recognizing the interplay among excess or dysfunctional adiposity, metabolic risk factors, chronic kidney disease, and cardiovascular disease. This narrative review discusses its definition, staging, pathophysiology, epidemiology, risk assessment, and evidence-based interventions. The American Heart Association staging system classifies CKM health from stage 0 to stage 4 and emphasizes that the greatest opportunity for prevention occurs before clinical cardiovascular disease develops. Assessment should include adiposity, blood pressure, glucose and lipid metabolism, estimated glomerular filtration rate, urine albumin to creatinine ratio, social determinants of health, and absolute cardiovascular risk. The PREVENT equations extend risk estimation to total cardiovascular disease while incorporating kidney function, and the 2026 ACC/AHA guideline advances from predicted risk toward expected treatment benefit. Management should be guided by phenotype, stage, and proven clinical outcomes. Lifestyle interventions, blood pressure and lipid control, renin-angiotensin system blockade, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and finerenone have complementary roles in eligible populations. Implementation requires systematic screening, multidisciplinary integration, and improved access. The CKM framework offers a clinically useful approach to replace fragmented decisions with longitudinal prevention based on risk, organ damage, and expected therapeutic benefit.