Panminerva Med. 2026 Sep;68(3):130-143. doi: 10.23736/S0031-0808.26.05449-2.
ABSTRACT
Chronic kidney disease (CKD) is increasingly recognized as a systemic disorder driven by metabolic dysfunction, vascular injury, inflammation, and emerging filtration phenotypes. In the cardio-kidney-metabolic (CKM) era, renal biomarkers such as estimated glomerular filtration rate (eGFR) and albuminuria provide essential insight into early metabolic-renal stress and cardiovascular (CV) vulnerability. This narrative review synthesizes contemporary evidence linking CKD to cardiovascular disease (CVD), emphasizing the multidimensional interactions among filtration impairment, glomerular barrier injury, metabolic dysfunction, and inflammatory pathways. Novel filtration phenotypes defined through creatinine-cystatin C (Cr-CysC) eGFR (including glomerular hyperfiltration and selective hypofiltration) highlight the limitations of classical staging and underscore the need for refined risk assessment. The integration of kidney markers into the AHA PREVENT equations represents a major advance, enabling absolute CVD risk estimation across the CKM continuum. Simulation-based analyses of 5000 virtual patients visually demonstrate the nonlinear and synergistic effects of eGFR, albuminuria, age, hypertension, diabetes, and lipid abnormalities on CV risk. Furthermore, disease-modifying therapies such as SGLT2 inhibitors, finerenone, GLP-1 receptor agonists, and anti-obesity interventions provide multisystem benefits that align with CKM pathophysiology. Together, these developments support a unified, continuum-based approach to CKD detection, risk stratification, and prevention, positioning CKD as a central driver of long-term CV outcomes.
PMID:42895046 | DOI:10.23736/S0031-0808.26.05449-2