Risk stratification of metabolic disorder–associated kidney disease

During the last 20 years, the disease burden attributable to metabolic disorders increased by 49.4%. Metabolic disorders are established risk factors for both chronic kidney disease (CKD) and cardiovascular disease (CVD). A concept of cardiovascular-kidney-metabolic (CKM) syndrome has recently been proposed to underscore the pathophysiological interrelatedness of the metabolic risk factors, CKD, and CVD. Two major adverse outcomes of the metabolic disorder–associated kidney disease are cardiovascular disease and, to a less extent, kidney failure. This review aims to briefly summarize the traditional metabolic risk factors for kidney disease; to introduce the concept of CKM health; to present the methods for risk assessment for CKD progression and CVD, with focus on validated and clinically applicable prediction tools; and to discuss the key gaps in the current tools for the risk stratification. In summary, in general clinical settings, the CKM health and associated risk in patients with the metabolic disorder–associated kidney disease can be assessed by combining the CKM staging model, the CKD Prognosis Consortium equations for CKD progression, and the Predicting Risk of CVD Events (PREVENT) equations for CVD. More efficient risk prediction tools, potentially incorporating multimodal data, are needed for more accurate and early identification of individuals at high risk and better personalized management of the disease.