Redefining Cardiometabolic Disease: Expert Consensus on the CardioVascular–Kidney–Liver–Metabolic (CVKLM) Multiorgan Staging
Guillaume Baudry, Jan Biegus, Juan Carlos López-Azor, Biykem Bozkurt, Javed Butler, Marta Cobo-Marcos, Jeroen Dauw, Sven Francque, Nicolas Girerd, Jennifer B Green, Mateusz Guzik, Gracjan Iwanek, Masatake Kobayashi, Peder Langeland Myhre, Marco Metra, Òscar Miró, Wilfried Mullens, Alberto Palazzuoli, Piotr Ponikowski, Claudio Ronco, Patrick Rossignol, Arun Sanyal, Carmine Zoccali, Muthiah Vaduganathan, Harriette G C Van Spall, Faiez ZannadAbstract
Cardiometabolic diseases increasingly manifest as interconnected dysfunction across the heart, vasculature, kidneys, liver, and metabolic system. The global rise in obesity, insulin resistance, and diabetes, together with therapies benefiting multiple organs, has reshaped the epidemiology and understanding of cardiometabolic disease, exposing the limitations of organ-specific or single-stage approaches.
The cardioVascular–kidney–liver–metabolic (CVKLM) framework is a multidimensional staging system in which cardiac, vascular, kidney, liver, and metabolic involvement are graded independently from absent to advanced. Analogous to tumour–node–metastasis staging, it provides a standardized language describing disease severity within each organ and its distribution across organs. Rather than replacing existing classifications, CVKLM integrates universal heart failure stages, validated vascular risk assessment, KDIGO chronic kidney disease stratification, contemporary metabolic dysfunction-associated steatotic liver disease (MASLD) and advanced liver disease criteria, and current definitions of diabetes and clinical obesity.
Unlike hierarchical frameworks assigning a single overall stage, CVKLM preserves organ-specific information and records coexisting abnormalities across domains. Intended for clinical and research phenotyping and staging rather than as a validated global risk score, it may facilitate systematic recognition of concomitant organ disease, support existing organ-specific diagnostic, referral, and treatment pathways, and provide a standardized taxonomy for observational studies and clinical trials. The prognostic significance of CVKLM profiles, their incremental value beyond established risk tools, and their clinical utility remain to be established.
By integrating these domains within a common architecture, CVKLM offers a pragmatic framework spanning the full spectrum of cardiometabolic disease, from preclinical involvement to advanced multiorgan failure.