The Kidney Collective: "A New Frontier"

Dr. Chiadi Ndumele: And this is not about labeling a whole lot of individuals with new conditions. It's actually just reflecting the reality of more and more what we're seeing in our everyday lives. So it is very important that we need to be thinking about this as something that is a continuum occurring for a large segment of the population. And it is, in fact, the case that we all need to be thinking about this because it's increasingly what's driving risks for kidney disease and cardiovascular disease in the population.

Mike Spigler: Welcome to the American Kidney Fund's podcast, The Kidney Collective. Today we have a special episode of the podcast, and I'm happy to introduce my co-host for this episode, Dr. Pranav Garimella. Dr. Garimella is a nephrologist and AKF's first chief medical officer. Thanks for joining me today, Pranav.

Dr. Pranav Garimella: Thank you, Mike. Pleasure to be here.

Mike Spigler: We are joined today by Dr. Chiadi Ndumele. Dr. Ndumele is the director of obesity and cardiometabolic research, director of the Heart Failure Prevention Program, and Associate Professor of Medicine and Epidemiology in the Division of Cardiology at Johns Hopkins University. He is a preventive cardiologist with doctorate level training in epidemiology and is the chair of the Council on Lifestyle and Cardiometabolic Health of the American Heart Association. He's also past chair of the AHAA Obesity Committee and co-chair of the AHA Cardiovascular Kidney Metabolic Health Initiative.

Dr. Pranav Garimella: He joins us today to talk about the first ever guidelines on cardiovascular-kidney -metabolic syndrome, or CKM syndrome, which were released in June 2026. Dr. Ndumele was the chair of the guideline writing committee, which were developed by the American Heart Association, the American College of Cardiology, and the American Diabetes Association, along with the American Society of Nephrology.

Mike Spigler: Thank you for joining us, Dr. Ndumele. We've got a great partnership that we have with the American Heart Association, and we're so excited to be working with the American Heart Association on these new guidelines that have come out. But for our listeners who might be hearing this for the first time, that there are new guidelines, what exactly is cardiovascular -kidney-metabolic syndrome? We call it also CKM syndrome for short. And why did we need a new way to describe how the heart, the kidneys, and metabolism are connected?

Dr. Chiadi Ndumele: Well, first of all, thank you so much for having me. It's quite a pleasure to be here. And I too greatly treasure the collaboration and partnership between AHA and AKF. So it's just uh great to be here representing that with you all here today. So the concept of CKM syndrome really stems from the fact that we are seeing a growing number of individuals who are reflecting this interrelationship among metabolic risk factors, things like obesity and diabetes and hypertension with uh chronic kidney disease and the cardiovascular system. We know that each of these entities are very, very closely interconnected such that it actually has become less and less both practical and appropriate to treat them as individual siloed conditions, or rather to consider them as an interconnected whole. Additionally, it's very much the case that the therapeutic agents that we use for these conditions really cross a lot of our subspecialty silos and don't just affect one system, but often affect multiple systems at the same time. This CKM syndrome concept is one that, because of the growth of obesity and diabetes and then resultantly chronic kidney disease in the population is increasingly becoming the leading cause of cardiovascular disease risk and premature mortality. So there's a lot of urgency behind this, but also increasing scientific understanding and also a lot of opportunity with neurotherapeutic agents that allow us to move beyond a siloed approach and think about this in a more interconnected, holistic way.

Mike Spigler: That's really fantastic. And we're so excited to see this work moving forward because, as you know, we in the kidney community, we've been seeing this for so long. And I think for the listeners that are hearing this, I'm sure they're thinking, well, gosh, I know I tons of people that have either obesity or high blood pressure or kidney disease. And in fact, AHA has estimated that 90 to 95%, so almost everyone of U.S. adults fall somewhere on that CKM spectrum. That's a staggering number. Does this mean that CKM syndrome is something that every American should be talking to their doctor about? And what does it mean that these conditions aren't just related? They actually drive each other?

Dr. Chiadi Ndumele: So I think there's a couple of things that are very important here. So, first of all, and we'll be talking more, I hope, about the staging for CKM syndrome, but it does occur along a spectrum. So we do see individuals, that 90% mark reflects people who are both in these earlier stages of CKM syndrome, and then a smaller number, about 15%, who are in the more advanced stages of CKM syndrome. But that spectrum is important because it does represent a lot of opportunity for actually preventing progression to those later and more harmful and more complex stages. So I think that that's one piece that's very important. And this is not about labeling a whole lot of individuals with new conditions, it's actually just reflecting the reality of more and more what we're seeing in our everyday lives. So it is very important that we need to be thinking about this as something that is a continuum occurring for a large segment of the population. And it is, in fact, the case that we all need to be thinking about this because it's increasingly what's driving risks for kidney disease and cardiovascular disease in the population. So I think that that's very true.

Dr. Pranav Garimella: Thank you. That's such a great point you make. And yes, we will talk about staging a little further into this conversation, but I wanted to take a step back and you know talk about the significance of the CKM guidelines that were just released and of which you're the lead author. Can you explain to our listeners really the purpose of these guidelines and what the main factors that you and the work group took into consideration while developing them?

Dr. Chiadi Ndumele: So, one of the good things about this space is that we have not a scarcity of evidence. So this is a very fertile place for research and investigation. Most of our major clinical trials have been in this space in recent years. So there was a lot for us to draw from as a writing committee. I think it really falls into a few major buckets. The first overarching piece, I will say, is that our writing committee was not a writing committee of cardiologists. It was a pretty evenly balanced group that included not only cardiologists, but endocrinologists, nephrologists, of course, primary care physicians, both adult and pediatric providers, as well as pharmacists, nurses, and patient advocates. And I think it's really important to have that multidisciplinary perspective to address what is a multi-system challenge. So I think that's the first piece. The other piece that is really important is that it is very often the case that CKM syndrome and a lot of its comorbid conditions are very frequently undiagnosed, unrecognized, or under addressed. So we really wanted to have a lot of attention about calling attention in a timely fashion to these conditions as they emerge so that we could actually start to address them in a more timely fashion. We also wanted to move beyond just thinking about these as individual siloed conditions, and as we've talked about, think about them as this interconnected whole and think about them in our therapeutic approaches as well as in our diagnostic approaches and how our care model looks to address this. And then finally, we have this increasing array of therapies with multi-system benefits. So we want to really equip individuals about how to best deploy these therapies, how to target these therapies from optimal multi-system benefit. And I wanted to emphasize that this is not an AHA ACC guideline alone. This is AHA ACC ADA ASN. And it really brings together multiple specialties to have a harmonized approach because very frequently it's the case that we have patients, all of us, as I myself as a cardiologist, have patients who have these multiple conditions because that's what they're experiencing. But the cardiologist wants to look at it from the cardiovascular perspective, the kidney doctor might want to look at it from the kidney perspective, the endo cardiologist from the ethical perspective. And it's very easy for not only there to be mixed messages, but also for things to fall through the cracks in that fragmented model. So it's important for us to have an interdisciplinary approach so we can be more holistic in how we're thinking about this. And that was a really big focus of this guideline as well.

Dr. Pranav Garimella: Thank you. That's that that was a great response as to how you're bringing the pieces together and solving the puzzle rather than looking at them in individual through an individual lens. You mentioned earlier that you've organized CKM syndrome into stages. So stage zero through four. And I was wondering if you could briefly explain what the criteria are for each stage. For example, someone who feels perfectly healthy, but perhaps has a little central adiposity around them, and they've been told that they might have prediabetes, why do they fall into stage one and not zero? And, you know, what was the thinking behind these stages or the spectrum of cardio-kidney-metabolic syndrome?

Dr. Chiadi Ndumele: First of all, although when we think about CKM syndrome, and I as a cardiologist, and probably yourself as a nephrologist, we are often thinking about that patient who's coming to us who already has full-blown manifestations of all these challenges. You know, advanced kidney disease, cardiovascular disease, and overlapping metabolic risk factors. And often very challenging to keep out of the hospital, very poor outcomes, a lot of costs and morbidity associated with that in addition to mortality. But the reality is there's a very typical, gradual pathophysiologic progression to CKM syndrome. And that does represent a lot of opportunity for actually halting progression to those later stages and improving overall outcomes. So the CKM staging is very much meant to reflect that typical pathophysiologic progression. First, it starts with stage zero, which I want to clarify is not part of CKM syndrome. Those are individuals who have really ideal cardiovascular health, and we want to keep people there for as long as possible. And we'll just kind of emphasize that as a positive in terms of thinking about the staging approach. Stages one to four represent that typical progression. And I will say that the primary outcome focus for the staging is, in fact, cardiovascular disease, and that was a big decision. We had a lot of discussion amongst all the various specialties, and the reason there was a broad agreement for that is because what's driving mortality and what has the greatest incidence, not just for patients with diabetes, but certainly for patients with chronic kidney disease, as well as all the metabolic risk factors, is cardiovascular disease. And in fact, it's frequently the case that patients with advanced CKD, cardiovascular death, actually precludes progression to actual dialysis or kidney failure. So it's important that we kind of wanted to set what's the metric we're looking at. So the stages start with number one, stage one is that excess or dysfunctional adipose tissue. That is what's on the rise in the population. That is really the precursor to so much of the multi-system disarray we see. That's defined by a BMI that's elevated or greater than 25 or above. Its waist circumference is elevated, which is a waist circumference of 88 centimeters or greater in women or 102 centimeters or greater in men, or evidence of prediabetes. It's even in the absence of elevated anthropometric measures. Now, this, particularly when we see abdominal adiposity, is the precursor to so much of what we see with C cannon syndrome. Stage two is then the emergence of these metabolic risk factors like diabetes and hypertension, hypertriglyceridemia, or moderate to high risk chronic kidney disease, and a combination of those. And those are the precursor to stage three, which is really the presence of subclinical cardiovascular disease, early changes in either the heart structure or function, or early atherosclerosis, or risk equivalents like very high-risk chronic kidney disease or high predicted risk using our prevent risk calculator that includes kidney and metabolic measures in its calculation. That is the precursor to clinical cardiovascular disease in stage four, overlapping with those metabolic risk factors and/or chronic kidney disease, and that could be divided into patients who have kidney failure or patients who do not have kidney failure. So 4A and 4B. The point is that rather than just focusing reactively on seeing the patient already comes in with all the bad stuff, this gives us an opportunity to focus on life course prevention. Thinking about the opportunities, the windows for earlier detection and earlier prevention of progression. And we know from epidemiologic data that that progression to those later stages is very, very strongly associated with increased risk of premature mortality. And that's the curve we're trying to bend. I will say one quick last point, which is that if you look at the mortality curves in the population over the last several decades, we've had five decades of continuous declines in cardiovascular mortality. In the last decade, it has now plateaued and begin to uptick. And that is simply because of this emergence of CKM syndrome, obesity, diabetes, and chronic kidney disease. So we need more attention to this clinically so we can again get those mortality curves going in the right direction.

Mike Spigler: Thank you very much. You know, and I love the idea of a stage zero because it's always saying that risk is always there, right? This is something that so many people deal with. And honestly, it's probably something we should be thinking about even in kidney disease instead of starting at stage one. Maybe the stage zero is like, you know, this is something that can affect anyone at any time, really. One of the things that I think we always get asked about here in kidney disease and the stages of kidney disease is can I get better? Can I regress back the other direction? And until recently, and there's maybe some data showing maybe that is slightly possible, some of the new therapies that are out there, but it's not something that we are used to in the kidney community, but it seems to be something that is possible in CKM syndrome. Can you talk about that regression and how that works?

Dr. Chiadi Ndumele : Yeah, no, it's a very important concept. And obviously it starts with the awareness of where you are along that spectrum, but regression is very possible. So the idea is that we can see that with substantial lifestyle change and particularly with substantial weight loss and loss that excess and dysfunctional adipose tissue that's the driver of so much of this, we can actually see individuals lose the criteria for those stages. So going backwards from the stage, let's say, uh three, if it's based on cardiac remodeling and early kind of evidence of pre-heart failure to stage two, those metabolic risk factors of CKD, to stage one, where you have the absence of those conditions, or it actually with even substantial changes. We could even see going back to stage zero, which is really that focus on uh where we have that more of that ideal cardiovascular health. So there is a lot of opportunity, and now our tools for supporting that lifestyle change and weight loss are so substantial. So it's important, yes, we see individual parameters like albuminuria can get better with this. We can see blood pressure and lipids get better with this, we can see inflammation get better with this, but collectively, we can actually see people lose the criteria for those later stages, and that kind of has a dramatic impact on overall outcomes of the population.

Mike Spigler: Yeah, and it's just a message of hope, right? I mean, people have got something that they can move towards. I mean, I think that's something that's just human nature to want to be able to do that. So at the American Kidney Fund, we often say kidney disease is silent. It, you know, many symptoms don't show up until it's very advanced. Why does the new guideline call for doctors to use two different tests? Many people get the blood test for kidney disease, part of an annual workup uh for kidney function. You may see it on your on your lab report as eGFR. But very often the urine test doesn't come with it as well. And why is it so important to get both of those tests, especially to get a full picture of someone's CKM risk?

Dr. Chiadi Ndumele: Yeah, so I think this is a great example of a place where the rest of the world is joining the party, that I think a lot of the kidney doctors have been hosting for some time. And I think, you know, we, as this data has become more and more robust, appreciate that estimated GFR using, you know, creatinine or cystatin C or combination-based uh formulas and urine albumin to creatinine ratio really are both important, not only for the diagnosis of chronic kidney disease. So you can have chronic kidney disease by persistent abnormalities in both of those measures, but they also provide tremendous complementary information, not just about risk for kidney failure, but also about risk for every single form of cardiovascular disease, as well as risk for premature mortality and other adverse health outcomes. Additionally, the guidelines actually use the urine albumin-creatinine ratio in a few other ways. Both of those, eGFR and uACR, are helpful for the risk estimation and they're part of the prevent risk equations. And additionally, that presence of uACR we look at as a marker of persistent renovascular risk. And that when we see that being persistently elevated, that's a marker for where we need to intensify some of our therapeutic approaches, particularly for those individuals with diabetes and chronic kidney disease, where we have some of the strongest clinical trials evidence in that space for adding combination therapies. So there's a lot of good reasons to assess that. The other thing I will mention is we specifically focus on this for individuals who are in that stage two, three, and four, where they have either existing metabolic risk factors or chronic kidney disease, because we know we have a pretty significant prevalence of albuminuria in that population, and we just don't want to miss that because we know we're getting additional information and it can guide our therapeutic approaches.

Dr. Pranav Garimella: Fantastic. Thank you so much. And you've mentioned a couple of times now the PREVENT equation, and we in clinical medicine always want to develop tools that tell us about future risk. How can we stop it? How can we change the course? How do we change cardiovascular risk? How do we change the trajectory of GFR? Can you tell us a little bit about the PREVENT equation and how is this different from existing ones? And how do we operationalize this in clinical care and who should get it?

Dr. Chiadi Ndumele: Yes, so the PREVENT equation is an important advance uh from our prior equations for risk. And it's not just relevant to the cardiovascular doctors, as I've mentioned, it's relevant to really all specialties because in the CKM syndrome population, cardiovascular disease is a primary outcome that we need to be concerned about here. The PREVENT equation is indicated for those individuals who are uh don't yet have cardiovascular disease. So in stage zero through three, and what I would do is describe it as a quantitative risk assessment approach that's really complementary to the qualitative approach that's used with the staging. So the staging tells you where along this risk factor you are. It certainly correlates with your absolute risk or the higher incidence of cardiovascular disease, but the quality, the quantitative approach with the staging is a great complement to that because there's a lot of variability within each of the stages. So the CKM, the reason why the prevent estimation is important is a few things. Number one, unlike prior equations, it includes a lot of these CKM risk factors, including EGFR and when indicated urine albumin-creatinine ratio, in addition to the other CKM risk factors. Number two, we know that a lot of what we're seeing, and particularly in relation to chronic kidney disease, is heart failure as an important clinical outcome. Our prior risk tool, the pulled cord equation, focused just on atherosclerotic cardiovascular disease and PREVENT moves beyond that to also look at uh heart failure as an outcome as well as total cardiovascular disease, the composite of atherosclerotic cardiovascular disease and heart failure. Additionally, it looks at risk for individuals starting at age 30. So previously we started at age 40, but we're seeing individuals developing disease earlier and earlier. And it looks at risk over a 10-year time horizon, which is really relevant for older adults, but then also over a 30-year time horizon, which is going to be even more helpful for younger and middle-aged adults who might not have a short-term high risk, but in the long term are still having very high substantial risk. And this is a tool that was really helpful. There's a website that you can easily find if you just Google PREVENT, and basically gives anybody an estimation of where their risk is. We use it to guide therapies. So individuals who have a risk that's greater than 7.5% of PREVENT CBD are individuals who were going to prioritize a lot of these protective CKM therapies like GLP1s and SGLT2 inhibitors. The reality is a lot of the individuals who have chronic kidney disease, particularly at the later stages, are going to exceed that threshold, but it's a really important tool for helping us help individuals understand where they are in terms of their overall risk. And then, as I've mentioned previously, once you get that prevent score greater than 20%, that's a risk equivalent for stage three. That stage three population is a very high risk population. In fact, their risk for cardiovascular events is similar to those for individuals who have existing cardiovascular disease. It's almost a risk equivalent for that. Therefore, when we identify those individuals, we hopefully we can prevent people, more and more people, from getting to that stage. But when we do get there, we kind of want to throw the kitchen sink because those are the individuals that are at the greatest risk of moving to some of these very, very bad outcomes in premature mortality.

Dr. Pranav Garimella: Thank you. For that tour de force on how to interpret and use the PREVENT equation. So, for example, in a situation now where a clinician has used a PREVENT equation and someone has an estimated risk of cardiovascular disease, and they've also now been staged into a non-zero CKM syndrome. What next steps should they as patients take to help slow down their progression? And perhaps once you answer that, you can also tell us what should their clinicians consider to help them further slow down progression of CKM syndrome?

Dr. Chiadi Ndumele: So a lot of this is going to start with awareness and recognition. And I think so much of what happens with CKM syndrome is unrecognized until we get to those later stages when it's really harder to achieve some of the most optimal outcomes. So I think that's the first piece is the awareness of where you are along that staging spectrum as you described, and then where your overall predicted risk is. And that's an empowering thing for patients to take to their clinical appointments. And they can you can check that as a patient for yourself and understand what that risk looks like. I think in terms of the approach therapeutically, it's always going to start with healthy lifestyle modification. And I want to make clear that that's not just something that's in the laps of patients. That's something where we have increasing tools that can support that through behavior change because so much of lifestyle is governed by these adverse social determinants of health. There's so many forces that are governing how we eat, how we sleep, how we exercise. So there's a real need for ongoing support to kind of address that and kind of move past a lot of the barriers to healthy lifestyle. So that's going to be the foundation of it all. But on top of that, I would say there's two major additional points to consider therapeutically. Number one, we need to look at risk factors collectively. So it's not just, it's rarely the case that we just see the patient, you know, we'd have a glomerulopathy or some other thing could happen, but most of the time, it's not just a patient with CKD. It's CKD accompanied by other metabolic factors, which can really guide not only are impacting the kidney disease, but are guiding their impacting the overall risks. And that should be part of our therapeutic approach. Secondly, we have these therapies, these CKM therapies, and several of these therapies, so SGLT2 inhibitors, for example, obviously they're a powerful first-line therapy for addressing CKD, but they also have some metabolic benefits. They also reduce cardiovascular death with a particular impact in heart failure hospitalizations. GLP was, yes, they've been shown in the flow trial in patients with diabetic kidney disease to reduce kidney events, but they also reduce all-cause mortality and cardiovascular events, particularly heart failure events. And on top of that, we know that they have metabolic benefits with weight loss and reductions in insulin resistance and reductions in inflammation and blood pressure and lipids and all these other benefits as well. Finerenone, the non-sterental mineral corticoid receptor antagonist, we know that that is beneficial in diabetic kidney disease as well. And fine CKD, the newest study, seems to suggest some benefits in patients who have kidney disease without diabetes. But on top of that, we know that they also have some very substantial benefits in the cardiovascular system, particularly on heart failure events. So the importance is that we need to have better recognition of the multi-system challenges that are going on. We need to start thinking about collective control for these risk factors, and that's been shown to be associated with lower mortality and lower cardiovascular events and kidney events, and we need to effectively deploy some of these multi-system therapies that are not just kidney therapies, but they have benefits that extend from multiple systems. And having awareness of your patient's risk profile can guide which one are you going to be most likely to choose. So if I see a patient who has pre-heart failure or CKD, I might be prioritizing the SGLD2 inhibitor. If they have the CKD, but they also have a lot of obesity and a lot of very high MACLD, for example, fatty liver disease or very high glucose, I might be prioritizing the GLP1. So just considering the broader risk profile as you're making therapeutic choices.

Mike Spigler: You know, you talked a lot about awareness and education and the importance of that. You know, the American Kidney Fund has a great program called our Kidney Health Coach program. We've had it for several years now. And uh we have almost 9,000 coaches uh in every state, every territory, and actually now we have almost 50 countries of volunteers that are going out and educating uh their neighbors and family members about uh kidney disease. And the great thing is we've now partnered with the American Heart Association to create uh an online course, all of them are free on cardio -kidney -metabolic uh syndrome for our coaches to go out in the community and and provide this because not everyone, especially those that I mean, some of the ones that are most at risk and underserved are folks that may not be able to listen to a podcast easily, right? Or or or have ready uh access to the internet. So these community programs we feel are important, but I would love to get your thoughts on the importance of those kinds of programs, those peer-to-peer community health outreach programs in the context of something that's relatively recent like CKM.

Dr. Chiadi Ndumele: So I think that's a great question, and I'm really happy you brought it up because I think that program is profoundly important. So, first of all, as you mentioned, social determinants of health are really important to the natural history of CKM syndrome. The people who are most affected tend to have the most social challenges. They're more likely to develop these conditions, they're also more likely to have challenges with self-care, accessing care, even more likely to not be detected in a timely fashion, and certainly most likely to develop these complications. So I think that's the first thing. In general, we think it's very important to reach these individuals, and that involves also thinking about it in the broader social context. But a very important part is just being able to communicate this risk, being able to provide support for the care pathways, even helping people understand the interconnectedness of these conditions, that it's not just bad luck. And then certainly there's broader questions about navigating the fragmented health system, about understanding what these tests mean, about helping individuals in the journey to optimal health. There's nothing, I don't think, more powerful than individuals who are in your community giving voice to this in a way that you can trust and understand. I mean, I certainly I've worked I've worked in Baltimore for the last 20 years, and I certainly love engaging with my patients, but there's something very powerful about those individuals who are right from that community, speaking with a common voice that really has a direct line and impact to those individuals who are most affected. So I think that the AKS program is substantially important, and I think is one of the most important ways for us to reach individuals in the community who are most likely to be affected by these channels.

Dr. Pranav Garimella: I wanted to ask you specifically about the clinical guidelines emphasizing a non-judgmental approach, because we tend to have preconceived notions sometimes about management of certain conditions, and unfortunately, obesity is one of them. And so why is it so important for clinicians to approach obesity as a complex medical condition rather than something that the patient has chosen to be?

Dr. Chiadi Ndumele: Yeah, I think this is a very important piece. And given that uh excess and dysfunctional adiposity are so much at the core of most of this multi-system disarray we see, we do need to have more effective clinical approaches to addressing this. I think one of the biggest challenges we've had with obesity is that we tended to see it as an individual failing, as just a personal responsibility rather than the more complex multi-system challenge that it is. That doesn't just have uh behavioral components, but also biological components and certainly very, very wide and deep social components that are impacting this as well. On top of that, once obesity develops, there are so many multiple biological compensatory mechanisms that makes it more likely that it stays there after the fact. And everybody who's uh, including myself, who's been on uh tried to do lifestyle changes and seen those things discouragingly come back can attest to the chronicity of those challenges. So at the end of the day, this really is a complex multi-system challenge, but we tend to approach it in a very judgmental and by and stigmatizing way. We have a lot of bias, weight bias, and it's never no more, it's it's as rampant as anywhere as it is in clinical communities. What does happen is when we do that, we see less effective weight loss efforts, and it's more likely people are gonna stop actually uh seeking care. On the flip side, number one, the people who are least likely in the clinical side to take a judgmental approach are those who have an understanding of the complexity of obesity, and that non-judgmental approach is associated with the best weight loss outcomes and the best overall uh benefits for patients. So we want to move towards that. There's a stop obesity alliance toolkit that is emphasized within the guideline as a roadmap for how to have those discussions, but that's somewhere that we need to get more sophisticated, and it's important now more than ever because it's at the root of so much of what we're seeing in terms of the multi-system child is in CKM syndrome.

Dr. Pranav Garimella: Thank you for elucidating that. I think you've beautifully outlined as to the guidelines by creating the idea that someone's zip code is just as strong in terms of the its effect on cardio-kidney-metabolic syndrome as their genetic code and the importance of managing social determinants of health effectively to actually make an impact on cardio-kidney -metabolic syndrome progression downstream.

Dr. Chiadi Ndumele: Yeah, I think that that's a very important. So where I live in Baltimore or in Maryland, but yes, even in Baltimore, you can see a dramatic, decades-long difference in mortality or in life expectancy just based on zip codes that are just a few, less than miles away from each other. This is a very big challenge and it's driving bad outcomes. It's also driving persistent disparities in the population. So considering these social determinants is a key part of holistic care in the CCAN syndrome model, so both identifying these and having individuals who are part of the care team, including, for example, the health coaches that are part of the AKF's mission, that can really help us to better reach those individuals who need help the most.

Mike Spigler: Well, Dr. Ndumele, first let me thank you for your leadership on this work and your willingness to be on the podcast on the Kidney Collective today. We really, really appreciate it. I want to leave with like a final thought. So, what is your ultimate hope for how these guidelines will change the lives of people living with or at risk for kidney disease over the next decade?

Dr. Chiadi Ndumele: So, you know, I think right now I see kidney disease and particularly the prevention of progressive kidney disease as one of the great frontiers moving forward. It was only recently that we started developing all these new therapeutic approaches that can halt this progression of kidney disease. And not only are we seeing benefits for kidney failure, we're seeing dramatic benefits for cardiovascular mortality and cardiovascular outcomes. This represents a new frontier. Number one, we have so many individuals who don't even know they have chronic kidney disease. Number two, we have so much risk associated with the condition. And number three, we now have several effective therapies, but we're not yet applying them effectively. So there's so much opportunity on the table for us to make a huge impact on population health by addressing and therapeutically uh you know treating chronic kidney disease. I think that there's so much opportunity for us to improve alchemies for the population. So I am super excited and grateful that there's obviously these uh opportunities there, but also for this partnership between AHA and AKF, because I think it's calling attention to really the next frontier in chronic disease prevention.

Mike Spigler: Well, I think those are great takeaways. And I want to thank you again for being here. We will certainly put links to the CKM guideline that AHA and that you led the authorship of. We'll put a link to Kidney Health Coachm or any other resources that you'd like to plug or promote before we wrap?

Dr. Chiadi Ndumele: No, I think that if you go online on the CKM guidelines, there's a great resource not only for clinicians from different specialties, but there's also resources for patients as well. And the PREVENT page as well is a great resource for individuals to be able to better understand their risk, including tools to be able to compare where you are in terms of your chronologic age to your biologic age, as well as where you are relative to your peers who are age and sex match. So I think there's now an increasing array of tools there. And I also think that your resources through the AKF and the Health Coaches with CKM are really an important additional resource for individuals as well. I think working together across specialties, there's a lot of potential for us to improve outcomes for the whole population.

Mike Spigler: Great. And that means there's a lot of hope for all of us. So thank you very much. We really appreciate it. And that brings to close today. I want to thank our guests and my co-hosts for being here today, and we'll see you next time.

Tamara Ruggiero: To find out more about the topics we discussed in this episode, or to access resources to learn more about kidney disease, go to the episode show notes on your podcast listening platform or go to kidneyfund.org/podcast. And if you haven't already, be sure to subscribe or follow The Kidney Collective wherever you listen to podcasts, and leave us a like or review to help us reach more members of the kidney community.

Mike Spigler: You can also follow AKF on all major social media platforms, including Facebook, Instagram, TikTok, BlueSky, LinkedIn, YouTube, Twitter/X, or whatever comes next. Join us next time. Remember that even in the toughest moments, there's hope ahead, and The Kidney Collective and AKF are here for you now.