The recently introduced cardiovascular-kidney-metabolic (CKM) syndrome captures the close interplay between metabolic risk factors, chronic kidney disease and cardiovascular disease, but underestimates the role of the liver. Metabolic dysfunction-associated steatotic liver disease (MASLD) — the world's most prevalent chronic liver disease — is strongly linked to cardiovascular events, kidney-disease progression and mortality, yet is often missed in practice. This multidisciplinary consensus statement proposes the concept of a cardiovascular-kidney-liver-metabolic syndrome (CKLMS) and offers a practical, primary-care-centred framework. Using accessible, validated tools — blood pressure and lipid profiling, kidney function and albuminuria, non-invasive liver fibrosis testing, and screening for diabetes and obesity — cardiovascular, renal, hepatic and metabolic risk are stratified together. It emphasises early lifestyle intervention, drugs with multi-organ benefit, and clear referral pathways, positioning the primary-care physician as coordinator of longitudinal, patient-centred care.
The recently introduced cardiovascular-kidney-metabolic (CKM) syndrome captures the close interplay between metabolic risk factors, chronic kidney disease, and cardiovascular disease, but insufficiently reflects the important additional role of the liver. Metabolic dysfunction-associated steatotic liver disease (MASLD), the most prevalent chronic liver disease worldwide, is strongly associated with cardiovascular events, kidney disease progression, and all-cause mortality, yet remains frequently under-recognized in routine clinical practice. We propose the concept of a cardiovascular-kidney-liver-metabolic syndrome (CKLMS) and present a multidisciplinary, primary care-centered framework for its assessment and management. Based on expert consensus and current evidence, the framework integrates cardiovascular, renal, hepatic, and metabolic risk stratification using accessible, validated tools feasible in primary care, including blood pressure and lipid profiling, assessment of kidney function and albuminuria, non-invasive liver fibrosis testing, and systematic screening for diabetes and obesity. Management emphasizes early lifestyle intervention, use of pharmacological therapies with multi-organ benefit, and clearly defined referral pathways to specialist care. Primary care professionals are positioned as coordinators of longitudinal, patient-centered, multidisciplinary management. Early, integrated identification and treatment of CKLMS in primary care represents a pragmatic and effective strategy to prevent disease progression, reduce cardiovascular and kidney events, and improve long-term outcomes.
