Patients with overlapping heart failure, chronic kidney disease (CKD), diabetes, obesity, and other cardiovascular-kidney-metabolic (CKM) conditions often do not fit neatly into single-disease treatment pathways. A common example is the volume-overloaded patient who needs diuresis but develops worsening kidney function as treatment intensifies. The American Heart Association’s 5-stage CKM framework recognizes these interconnected risks and emphasizes coordinated care across primary care, cardiology, nephrology, endocrinology, nursing, and pharmacy. The stakes are substantial: in an analysis of more than 387,000 patients, development of a new cardiorenal-metabolic condition was associated with healthcare cost increases of 130% for CKD, 84% for type 2 diabetes, 304% for atherosclerotic cardiovascular disease, and 475% for heart failure.
The biggest opportunities for improvement may lie in care delivery rather than another specialty or therapy. Medication changes during hospitalization, particularly diuretic adjustments, can become unclear after discharge when patients encounter different clinicians, fragmented electronic records, and incomplete medication reconciliation, increasing the risk of nonadherence, recurrent congestion, and readmission. Stronger discharge reconciliation, clearly assigned outpatient follow-up, and coordinated longitudinal monitoring may help close these gaps. Pharmacists may be especially valuable because they can manage complex dosing, navigate prior authorizations and medication access, and follow patients over time. The broader message is that effective CKM care requires clearly defined handoffs and shared accountability so patients with multiple interacting conditions do not become lost between specialties.
Reference: Steinzor P. Patients with CRM disease are outgrowing the silos built to treat them. AJMC. 2026 Jun 22.
Link: https://www.ajmc.com/view/patients-with-crm-disease-are-outgrowing-the-silos-built-to-treat-them
