The cardiorenometabolic syndrome as a new clinical paradigm in precision medicine

Rodrigo Daza-Arnedo, Comité de Riñón, Diabetes y Metabolismo, Asociación Colombiana de Nefrología e Hipertensión Arterial, Bogotá, Colombia
Carlos M. Restrepo, Departamento de Medicina Interna, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia
Diego Araiza-Garaygordobil, Unidad Coronaria y Urgencias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Brandon De la Hoz, Departamento de Medicina Interna, Facultad de Medicina, Universidad del Norte, Barranquilla, Colombia
Juan Montejo-Hernández, Comité de Riñón, Diabetes y Metabolismo, Asociación Colombiana de Nefrología e Hipertensión Arterial, Bogotá, Colombia; Departamento de Nefrología, Nephromedicall IPS, Medellín, Colombia
Javier Jiménez-Quintero, Facultad de Medicina, Universidad Militar Nueva Granada, Bogotá, Colombia
Mauricio González-Arias, Endocrinology Department, Metropolitan Hospital Center, Nueva York, EE.UU.
Jorge Rico-Fontalvo, Comité de Riñón, Diabetes y Metabolismo, Asociación Colombiana de Nefrología e Hipertensión Arterial, Bogotá, Colombia; Departamento de Nefrología, Nephromedicall IPS, Medellín, Colombia; Departamento de Nefrología, Facultad de Medicina, Universidad Simón Bolívar, Barranquilla, Colombia

Cardiorenal-metabolic syndrome (CRMS) is a pathophysiological interaction of metabolic, cardiovascular, and renal dysfunctions, sharing mechanisms such as chronic inflammation, insulin resistance, neurohormonal activation and vascular dysfunction. This progressive condition can begin in subclinical stages and evolve into established cardiovascular and renal disease. The CRMS staging classification stratifies patients from a stage with no risk factors (stage 0) to clinical cardiovascular disease with or without kidney failure (stages 4a and 4b). This framework guides interventions based on absolute risk and disease progression. The recently developed PREVENT model improves prediction of total cardiovascular risk (myocardial infarction, heart failure, stroke, and mortality) by incorporating variables from the cardio-renal-metabolic axis. Using this tool, therapeutic strategies can be personalized and patients who benefit most from intensive or combination therapies can be identified. Compared to traditional comorbidity-based approaches, CRMS demands an interdisciplinary, anticipatory, and patient-centered strategy. The implementation of integrated models improves clinical outcomes and promotes health equity. CRMS should be considered a strategic priority in precision medicine, public health, and global health policy.