A Perspective on the Role of Nephrologists in the Cardio-Kidney-Metabolic Syndrome.

In order to appreciate and define the role of nephrologists in the newly defined cardio-kidney metabolic (CKM) syndrome, we acknowledge the important shift that must occur from a specialty that has traditionally focused on treating people with organ failure, to one that needs to now embrace the concept of prevention, early diagnosis, and delay of progression as complimentary to historical roles as providers of dialysis and transplantation. We describe the value that nephrology can play in further refining the CKM model to acknowledge the importance of the diagnostic precision of CKD, and kidney outcomes, and question the linearity of the model, given the complexities of CKD and CVD. There is a need to redefine training programs, and care models to meet the needs of a rapidly expanding area, where nephrology expertise can be invaluable to both patient care and scientific endeavours. We encourage nephrologists to define our roles in diagnosis, test interpretation, pharmacology and research questions, and encourage more holistic care of CVD risk and management within our subspecialities. As nephrologists we should ensure that our distinctive skill sets, and our appreciation and understanding of nuances inherent in kidney care, are preserved and taught.