A multidisciplinary discussion of cardiovascular-kidney-metabolic (CKM) care highlighted a substantial gap between current recommendations and real-world implementation. Chronic kidney disease (CKD) sits at the center of this interconnected risk spectrum: about 40% of people with diabetes develop kidney disease, and stage 3 to 4 CKD carries cardiovascular risk comparable to subclinical atherosclerotic disease. Contemporary CKM treatment increasingly favors parallel initiation of renin-angiotensin system inhibitors, SGLT2 inhibitors, nonsteroidal mineralocorticoid receptor antagonists, and GLP-1 receptor agonists rather than sequential escalation. Yet uptake remains limited; registry data showed mineralocorticoid receptor antagonist use below 1%, with SGLT2 inhibitor and GLP-1 receptor agonist use approaching only 20%. Among 4,678 patients hospitalized with HFrEF, just 23% were discharged on quadruple therapy and 26% were considered fully optimized after accounting for kidney function.

Team-based care may help close these gaps. University Hospitals’ CINEMA model combines extended visits with clinicians, pharmacists, dietitians, nurse navigators, health coaches, and virtual support and has been associated with improvements in weight, blood pressure, glycemia, lipids, albuminuria, and use of guideline-directed therapies. Speakers emphasized that broader implementation will require more than issuing guidelines: practical strategies include embedding treatment decision pathways in the electronic medical record, using pharmacists to address medication access, deploying community health workers to tackle trust and social barriers, aligning quality measures with reimbursement, and strengthening handoffs between inpatient and outpatient teams. The message is highly actionable: CKM care increasingly depends on coordinated, multidisciplinary treatment initiation and follow-through rather than waiting for individual conditions to be managed in isolation.

Reference: Grossi G. Prescribing gaps persist in CKM care even as therapies multiply. AJMC. Published September 17, 2026. Accessed October 6, 2026. https://www.ajmc.com/view/prescribing-gaps-persist-in-ckm-care-even-as-therapies-multiply

Link:  https://www.ajmc.com/view/prescribing-gaps-persist-in-ckm-care-even-as-therapies-multiply