Evaluation, Management and Therapeutic Approach of Cardiovascular-Kidney-Metabolic Syndrome: A Multidisciplinary Delphi Expert Consensus.

Objective: We aimed to develop multidisciplinary recommendations for the management of cardiovascular-kidney-metabolic (CKM) syndrome in Spain. Methods: The Delphi method was used. The final questionnaire comprised 61 statements that were assessed using a 9-point Likert scale of agreement, from 1 = fully disagree to 9 = fully agree. A consensus was reached when 80% of answers in all specialties were in the range of 7-9. The overall median was used as a measure of the strength of agreement. Results: A total of 70 (97%) panelists met the selection criteria and completed two rounds, including cardiology (13), endocrinology (12), internal medicine (12), nephrology (14), and primary care (19). Among the 61 statements, a consensus was reached in 54 (89%). The consensus to be highlighted included the following: an excess and/or dysfunction of adipose tissue as the initial driver of CKM syndrome (median 8), CKM syndrome that includes both patients at risk (median 8) and those with existing CVD (median 8), coordination of patient management by the family medicine physician (median 9), the essential role of primary prevention in maintaining CKM health (median 9), the administration of drugs with demonstrated CKM benefit in both early-stage patients (median 9) and those in the advanced stages of the syndrome (median 9), and the importance of lifestyle measures (median 9), with a focus on intensive weight loss (median 9). Conclusions: This Delphi consensus offers multidisciplinary recommendations highlighting the importance of early recognition, integrated management, and the implementation of preventive and therapeutic strategies with established cardiorenal and metabolic benefits.