From Specialty Silos to Integrated Care: A Korean Initiative for Cardiovascular-Kidney-Metabolic Health

Cardiovascular disease (CVD), chronic kidney disease (CKD), diabetes, obesity, and various metabolic disorders have traditionally been managed within distinct clinical and academic domains [1]. However, these conditions rarely exist in isolation. They share risk factors and pathophysiological pathways, accelerate one another, and increasingly share therapeutic strategies. Beyond renin-angiotensin system inhibitors, the emergence of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists has further blurred conventional organ-based therapeutic boundaries [2]. Consequently, therapies once viewed through organ-specific indications are increasingly shared across cardiology, nephrology, and endocrinology to achieve cardiovascular, kidney, and metabolic protection.

The concept of cardiovascular-kidney-metabolic (CKM) syndrome provides a framework for addressing these interconnections. In 2023, the American Heart Association (AHA) formally defined CKM syndrome as a systemic disorder reflecting interactions among metabolic risk factors, CKD, and the cardiovascular system [3]. More recently, the ‘2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome’ provided the first comprehensive clinical practice guideline for CKM syndrome, transitioning the concept toward practical implementation by introducing a stage- and risk-based approach and recommending interdisciplinary care teams with a CKM coordination point person [4]. This development represents an important shift from managing individual diseases toward managing the whole patient across traditional specialty boundaries.

This transition is particularly relevant to Korea. Cardiology, nephrology, and endocrinology/metabolism have each achieved substantial advances in clinical care, research, education, and health policy. Yet these efforts have largely evolved within their respective specialty frameworks. A patient with diabetes, CKD, and CVD may therefore encounter multiple specialists, separate clinical pathways, and disease-specific recommendations despite having a single interconnected disease continuum. The challenge is no longer simply to strengthen each specialty independently, but to connect their expertise around the needs of the same patient.

Against this background, representatives of the Korean Society of Nephrology (KSN), Korean Society of Cardiology (KSC), and Korean Diabetes Association (KDA) held their first working-level meeting on August 24, 2026, to discuss the establishment of a national CKM collaborative framework, tentatively referred to as the Korean CKM Alliance. The significance of this initiative lies not merely in bringing three professional societies together. Rather, it represents a transition from parallel efforts by individual specialties toward a shared approach to an interconnected disease spectrum. At the meeting, the three societies identified the development of a Korean CKM care model adapted to the Korean healthcare environment as a key long-term goal. Proposed areas of collaboration include multidisciplinary CKM care models and clinical practice guidelines, joint academic and professional education programs, CKM registries and real-world data infrastructure, collaborative clinical research, public and professional awareness initiatives, and coordinated health policy proposals (Fig. 1). As an initial academic collaboration, a joint CKM session is planned for the 11th Congress of the Asian Pacific Society for Dialysis Access (APSDA) in conjunction with the 47th Annual Meeting of the KSN (APSDA × KSN 2027) in Seoul. These activities may provide a foundation for moving CKM care from a conceptual framework toward practical implementation.

Fig. 1. A proposed framework for integrated CKM care in Korea.

Schematic representation illustrating the transition from traditional specialty silos (Cardiology [KSC], Nephrology [KSN], and Endocrinology/Metabolism [KDA]) toward a patient-centered, integrated care continuum. The alliance is structured around 6 core strategic pillars: (1) Korean CKM care model development and multidisciplinary clinical practice guidelines, (2) joint academic symposia and continuing medical education programs, (3) national CKM registries and real-world data infrastructure, (4) collaborative clinical and translational research, (5) public and healthcare professional awareness campaigns, and (6) coordinated health policy proposals and primary-specialist referral pathways.

CKM, cardiovascular-kidney-metabolic; KDA, Korean Diabetes Association; KSC, Korean Society of Cardiology; KSN, Korean Society of Nephrology.

A Korean CKM model must not merely replicate other frameworks, rather, it should be tailored to Korea’s unique healthcare landscape. Korea’s nationwide health screening infrastructure may provide a unique platform for systematic CKM risk assessment. However, important gaps remain, including the absence of quantitative albuminuria testing in the current national health screening program and the need to incorporate CKM-specific cardiovascular risk stratification. At the same time, clinical care remains largely organized around individual specialties and diseases. Developing effective referral and co-management pathways, defining the respective roles of primary care physicians and specialists, and identifying appropriate points for multidisciplinary intervention will therefore be essential. Each discipline brings a distinct but complementary perspective to CKM health. From a cardiology perspective, CKD, diabetes, and obesity are major determinants of cardiovascular risk, heart failure, and atherosclerotic cardiovascular disease, making their early recognition and management integral to cardiovascular prevention [5]. Nephrologists address that cardiovascular and metabolic disorders are major drivers of CKD development and progression, while CKD itself markedly amplifies cardiovascular risk, positioning kidney protection as an essential component of CKM care [6]. From an endocrinology perspective, diabetes, obesity, and insulin resistance are important metabolic drivers of both cardiovascular and kidney disease, creating opportunities for early intervention before irreversible target-organ damage develops [7]. These complementary perspectives are increasingly connected by therapies that provide benefits across organ systems rather than within a single traditional specialty. Existing specialty-based initiatives can also provide building blocks for this shared framework. For example, the KSN’s Kidney Health Plan 2033, which emphasizes CKD prevention and attenuation of disease progression, is closely aligned with the broader direction of integrated CKM health [8].

Important challenges remain. Governance, practical care pathways, shared outcome measures, data infrastructure, and policy priorities will require careful consensus among participating societies. More importantly, multidisciplinary care should not simply add more specialists to an already complex patient journey. Its value should be judged by whether it reduces fragmentation, improves implementation of evidence-based therapies, facilitates communication among clinicians, and ultimately improves patient-centered outcomes.

The first meeting among the KSN, KSC, and KDA is only an initial step, but it signals an important change: from specialty-based silos toward collaboration around the patient. CKM syndrome challenges the traditional boundaries on which medical specialties have been organized. The task ahead is not to eliminate those boundaries, but to build effective bridges between them. Developing and evaluating a Korean CKM care model may provide an opportunity to translate this principle into clinical practice and national health policy and, ultimately, to reduce the growing burden of cardiovascular, kidney, and metabolic diseases in Korea.