The "Cardiovascular-Kidney-Metabolic" era in CKD management: Integrated risk factor control and prognostic benefits.

Introduction The association between integrated management of metabolic risk factors, as proposed by the Cardiovascular-Kidney-Metabolic syndrome concept, and cardiorenal outcomes in chronic kidney disease (CKD) patients is unclear; therefore, this study aimed to quantify this association, with a focus on specific risk factor combinations. Methods This retrospective cohort study included 42,763 patients with CKD from the China Renal Data System (CRDS). The degree of joint risk factor management was assessed based on 4 metabolic risk factors, namely, blood pressure, glucose, low-density lipoprotein cholesterol and body mass index (BMI). The association between cardiorenal outcomes and the degree of risk factor control or specific risk combinations was assessed using Cox proportional hazards models up to 64,699.25 person-years of follow-up. Results In CKD patients, the degree of risk factor management demonstrated a dose-dependent association with lower risks of cardiovascular disease (CVD) events and CKD progression. Patients achieving management of all risk factors had significantly reduced HRs for CVD (0.69; 95% CI: 0.61-0.79) and CKD progression (0.79; 95%CI:0.69-0.89) versus those with no management. The most protective combinations were blood pressure, glucose, and BMI management for CVD events (HR: 0.66; 95% CI: 0.57-0.77) and CKD progression (HR: 0.78; 95% CI: 0.69-0.89). Conclusions In this large CKD cohort, achieving simultaneous control of blood pressure, glucose, and BMI was associated with the greatest reduction in both cardiovascular and kidney outcomes, supporting integrated multi-target management within the CKM syndrome framework.