# CKM, CKD Staging, and Kidney Failure Risk

Staging describes disease; prediction estimates a specified future outcome. State the population, endpoint, and action every time you use a score.

![Infographic: CKM, CKD Staging, and Kidney Failure Risk](https://urinenephrology.org/visual-reference/images/ckm-risk.png?v=20261003c)

## Name the question before the tool

CKM stage describes interconnected cardiovascular, kidney, and metabolic disease. CKD classification describes cause, GFR, and albuminuria. KFRE estimates kidney failure; PREVENT estimates cardiovascular events. None is a substitute for the others.

## CKM stage tells a disease story

Stage 1 includes excess adiposity/prediabetes without other major CKM disease; stage 2 adds metabolic risks or CKD; stage 3 includes subclinical CVD or high-risk equivalents; stage 4 has clinical CVD with CKM factors. Use the published 2026 criteria for exact assignment.

## Always collect eGFR AND UACR

Preserved filtration with substantial albuminuria is not low-risk kidney health. Confirm persistent abnormalities, assign G/A categories, and ask about diabetes, BP, smoking, lipids, adiposity, and established CVD. Missing UACR is missing information, not A1.

## Use KFRE in its population

The four-variable equation uses age, sex, eGFR, and UACR and is used in CKD G3–G5. Do not apply it as a validated AKI or G1/G2 forecast. Explain the 2- or 5-year endpoint and that it is a population-based estimate.

## Translate kidney risk into action

KDIGO suggests 5-year kidney-failure risk 3–5% to support nephrology referral, 2-year >10% for multidisciplinary care, and >40% for modality education/preparation. Symptoms, cause, eGFR, and trajectory can justify action regardless of the score.

## Explain discordance with an example

A person may have established coronary disease and high cardiovascular risk but relatively low near-term kidney-failure risk. Continue secondary cardiovascular prevention while following CKD. A low KFRE never cancels the need for BP, lipid, smoking, or albuminuria-directed treatment.

## Supporting evidence

- [Supporting guideline or source](https://kdigo.org/wp-content/uploads/2026/04/KDIGO-2024-CKD-Guideline.pdf)
- [Supporting guideline or source](https://professional.heart.org/en/science-news/2026-guideline-for-the-prevention-detection-evaluation-and-management-of-ckm-syndrome)
- [Supporting guideline or source](https://professional.heart.org/en/guidelines-statements/2026-ahaaccadaasn-guideline-for-the-prevention-detection-evaluation-andcir0000000000001453)

## Source lessons

- [ckm staging kidney axis](https://urinenephrology.org/2025_UDPA_Lectures_Live/cardiorenal-disease/ckm-staging-kidney-axis.html)
- [ckm syndrome](https://urinenephrology.org/2025_UDPA_Lectures_Live/cardiorenal-disease/ckm-syndrome.html)
- [ckm vs kfre](https://urinenephrology.org/2025_UDPA_Lectures_Live/cardiorenal-disease/ckm-vs-kfre.html)

Read alongside the full lessons; the findings and decisions shown here require the stated clinical context.