Prerenalism—A Gap That Costs Lives, Hearts, and Kidneys

Chronic kidney disease (CKD) is a powerful risk enhancer for cardiovascular disease (CVD) and exhibits a dose association for higher rates of death and adverse cardiovascular outcomes by declining strata of estimated glomerular filtration rate (eGFR) and increasing albuminuria. The recently defined cardiovascular-kidney-metabolic (CKM) syndrome highlights the overlapping pathophysiological mechanisms between obesity, diabetes, and CKD, which amplify CVD risk in tandem with adverse socio-ecological factors. The emerging array of highly efficacious therapies for CKM conditions represents a vast opportunity to modify the global burden of CVD by identifying and treating CKD, given their congruent cardiovascular-kidney benefits. Importantly, CVD and premature mortality are the major competing risks for kidney failure in individuals with diabetes and CKD, and cardiovascular and survival benefits may precede protection from kidney failure with CKM therapies in high-risk CKD populations.