SÍNDROME CARDIOVASCULAR–RIÑÓN–METABOLISMO (CKM): AVANCES EN LA PREVENCIÓN Y EL MANEJO INTEGRAL BASADOS EN EVIDENCIA CIENTÍFICA

Abstract

ABSTRACT: The cardiovascular-kidney-metabolic (CKM) syndrome is a comprehensive clinical framework proposed in 2023 by the American Heart Association. This approach describes how the pathophysiological interconnections between adipose tissue accumulation or dysfunction, metabolic risk factors, chronic kidney damage, and cardiac conditions interact. The purpose of this systematic review was to summarize the scientific literature published from 2021 to 2026 on advances in the comprehensive management and prevention of CKM. To achieve this, we conducted an exhaustive search of databases such as PubMed/MEDLINE, Embase, the Cochrane Library, Scopus, and Web of Science, following the criteria of the PRISMA 2020 guidelines. We evaluated clinical guidelines, expert consensus statements, randomized clinical trials, meta-analyses, and key observational studies. Classifying this condition into five stages (0 through 4) helps stratify risk and guides clinical intervention from the earliest stages. In turn, the PREVENT assessment tools facilitate the calculation of 10- and 30-year cardiovascular events by integrating renal and metabolic markers. From a therapeutic perspective, treatment options with cardiorenal benefits particularly SGLT2 inhibitors and GLP-1 receptor agonists have been shown to significantly reduce serious cardiovascular outcomes, the progression of kidney failure, and overall mortality. In the context of Latin America and Ecuador, the high prevalence of obesity, type 2 diabetes, and hypertension, coupled with inequities in access to healthcare, further complicates the burden of disease. In conclusion, implementing a multidisciplinary strategy focused on healthy habits, close monitoring of key indicators, and early prescription of drugs with multiorgan protection is the most effective approach to slowing the progression of CKM and even reversing its stages.