Early detection of cardiovascular–kidney–metabolic (CKM) syndrome relies on detecting metabolic, renal, and cardiac abnormalities before irreversible organ damage. Biomarkers such as estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) are central to this process, yet their routine use appears limited. This study examines the implementation of renal and cardiac biomarkers in Lithuania.Individuals with advanced CKM stages have a substantially increased risk of mortality and reduced life expectancy [1-2]. Given the high prevalence and severe consequences of CKM, reliable diagnostics are essential for early detection and efficient management [3-4]. This study evaluated the use of key renal and cardiac biomarkers in Lithuania.This retrospective study analyzed national health data of 923,329 adults aged ≥40 years from the Electronic Health Services and Cooperation Infrastructure Information System (ESPBI IS). The use of eGFR, ACR and NT-proBNP testing across CKM syndrome stages, cardiovascular disease (CVD) outcomes, and CKM-related conditions was evaluated.A total of 34.8% of the study population met criteria for stage 4 CKM syndrome, defined by the presence of ≥1 CVD. eGFR was measured in approximately half of the study population, whereas ACR and NT-proBNP testing were infrequent. NT-proBNP was mainly evaluated in patients with heart failure (HF) (22.4%) and with multiple CVD diagnoses (24.5%). ACR testing was even less common, ranging from 17.2% in patients with chronic kidney disease to 5.4% in stroke. Among individuals with stage 1–3, ACR results were available in only 9.0%, and NT-proBNP results in just 4.9%.Annual measurement of eGFR and urinary ACR should become routine in patients with obesity, prediabetes, diabetes or any cardiovascular diagnosis, representing most individuals with CKM stages 1–4. ACR is important because it detects renal damage and strongly predicts cardiovascular events years before eGFR decline becomes apparent. NT-proBNP provides additional insight in HF, atrial fibrillation, multiple CVD, or suspected cardiac strain.This study identifies underuse of ACR and NT-proBNP testing, indicating missed opportunities for early CKM detection. Broader, guideline-directed implementation of routine eGFR and ACR testing, with NT-proBNP use in high-risk groups, provides earlier identification of reversible CKM stages and optimizes reno- and cardioprotective therapy.

Chronic kidney disease (CKD) is a major health problem for which early detection and appropriate management by the general practitioner (GP) are essential. It is unknown to what extent GPs adhere to the XXX national guideline “chronic kidney disease” in daily clinical practice and whether they could benefit from a clinical decision support system (CDSS).This study aims to evaluate guideline adherence in chronic kidney disease management in XXX primary care.Retrospective analyses of a GP database were performed. Adults registered by the 1st of April 2024 at a general practice of one of the XXX healthcare centres, with at least one abnormal estimated Glomerular Filtration Rate (eGFR) measurement and/or Albumin-Creatinine Ratio (ACR) measurement during the period of the 1stof April 2024 up until the 30th of September 2024 were included. Adherence to the guideline on “chronic kidney disease” by the XXX College of General Practitioners was assessed in patients with newly diagnosed CKD or potential CKD, evaluating repeat testing intervals, CKD recognition, cardiovascular risk management and medication prescription.Out of 681 patients, 234 had a first abnormal eGFR or ACR value. Less than half of the patients received a recommended follow-up test within the study period after a first abnormal eGFR or ACR test result. Almost three quarters of the patients received lipid panel tests and almost two-thirds received blood pressure measurements. Registration of the diagnosis code was low, whereas registration of the contra-indication code was slightly higher.A key strength of this study is its use of real-life data. However, several limitations should be considered, such as the relatively small sample size, the short follow-up period and the risk of missing data. The results on follow-up testing frequencies, lipid panel testing values, and CKD recognition were in line with those of previous studies. Performance of blood pressure measurements varied between studies.Limited guideline adherence was found for CKD management in XXX primary care, leaving room for improvement. A second, comparable study will evaluate the effect of the CDSS on quality of care in chronic kidney disease management. Keywords: Chronic kidney disease, primary care, guideline adherence

Despite robust evidence for SGLT2 inhibitors in chronic kidney disease, fragmented NICE guidelines across multiple conditions create implementation challenges in primary care. Understanding variation in uptake across patient groups in primary care could inform targeted quality improvement strategies.To evaluate adherence to evidence-based CKD management, identify SGLT2 inhibitor treatment gaps across comorbidity groups, and develop an integrated clinical decision support tool addressing guideline fragmentation.Retrospective cohort audit of 292 CKD patients at a UK general practice using ECLIPSE informatics platform. Inclusion criteria: ACR above 20 mg/mmol, eGFR decline exceeding 15 mL/min, or uncontrolled hypertension. Analysis included demographics, comorbidities, biochemical monitoring, blood pressure control, and medication adherence. An integrated clinical flowchart was developed combining CKD diagnostic criteria, NICE referral pathways, and evidence-based pharmacotherapy algorithms including SGLT2 eligibility criteria across all indications.279 CKD patients analysed (median age 70-79 years). Comorbidities: hypertension (86%), diabetes (44%), cardiovascular disease (32%), heart failure (11%). Blood pressure control achieved in 68%. High-intensity statin use: 87% secondary prevention, 78% primary prevention. Only 67 patients (24%) received SGLT2 inhibitors despite 165 meeting eligibility criteria, representing 35% treatment gap (98 patients). Critically, SGLT2 uptake varied significantly by comorbidity: heart failure patients achieved 61% uptake versus 47% in diabetic patients without heart failure. Among 64 patients with single eligibility criteria not receiving SGLT2, diabetes was sole indication in 36 patients (56%), while heart failure alone accounted for only 2 patients (3%). ACR monitoring remained suboptimal (71% completion). Audit triggered 156 blood test requests, 94 urine ACR requests, 48 SGLT2 initiations, 34 ACEI/ARB adjustments, and 24 secondary care referrals.Paradoxically, despite originating as diabetes medications, SGLT2 inhibitors show superior uptake in heart failure (61%) versus diabetic CKD (47%). This disparity reflects that heart failure guidelines mandate SGLT2 regardless of LVEF, whereas diabetes guidelines frame SGLT2 as HbA1c-dependent rather than renoprotective. Fragmented care delivery in England, where diabetes specialist nurses conduct reviews while GPs manage CKD, creates accountability gaps. Rapidly evolving guidelines across conditions further complicate implementation.SGLT2 underprescription in diabetic CKD represents significant quality gap. Integrated decision support tools and clear condition-agnostic renoprotection protocols could replicate heart failure pathway success.

Chronic Kidney Disease (CKD) commonly coexists with conditions forming the CAREMELO multimorbidity cluster—Cardio-Renal-Metabolic-Endocrine-Liver-Obesity. These interrelated conditions significantly influence disease progression, treatment burden and self-management demands. Despite this, patient education in primary care often focuses solely on CKD. Understanding patient needs across the CAREMELO spectrum is critical to designing effective, person-centred education.To examine patients’ understanding, confidence, multimorbidity burden, information needs and preferred learning formats in relation to CKD, and to use these findings to develop a CAREMELO-aligned CKD education programme suitable for primary care populations.A mixed-methods survey was distributed electronically to adults with recorded CKD in a rural primary care setting. Quantitative data were analysed descriptively, while qualitative free-text responses underwent inductive thematic analysis. Integration of both strands enabled a comprehensive assessment of needs, perceptions and barriers.A total of 210 patients responded (95.7% consenting). The cohort was predominantly older (65–79 years: 65%; ≥80 years: 28%). CAREMELO-related multimorbidity was common: breathing problems (36%), obesity (20%), heart disease (20%) and diabetes (14%). Confidence in managing CKD varied; 36% felt “not very” or “not at all” confident. Patients identified key information needs: understanding test results (58%), medicines and treatments (53%), diet and nutrition (46%) and exercise/weight management (26%). Preferred learning methods reflected mixed digital literacy: 64% preferred one-to-one clinician discussions, 24% face-to-face groups, 23% printed materials, and 23% online reading. Qualitative findings revealed significant communication gaps, including unexpected diagnoses delivered via text, confusion over CKD terminology, and limited opportunity for personalised explanation. Patients described difficulty managing overlapping cardiometabolic and respiratory conditions, reflecting CAREMELO multimorbidity.Findings demonstrate substantial unmet needs relating to understanding CKD and its multimorbidity context. Patients require clear explanations of test results, tailored guidance on lifestyle and medication, improved communication pathways and flexible, accessible formats.This mixed-methods evaluation informed the development of a CAREMELO-aligned CKD education programme incorporating personalised explanation, multimorbidity-focused content, multiple learning formats and improved communication. Such programmes may enhance confidence, self-management and holistic primary care support for patients with CKD.

Coordinated care (CC) in Poland has introduced several disease‑specific pathways in primary care, to answer the most important civilization health challenges, including cardiology, diabetology, pulmonology/allergology, endocrinology and nephrology. Those are important from whole Europe perspective. However, the nephrology pathway for patients with chronic kidney disease (CKD) is reported to be the least implemented in Polish PC. Meantime early detection and management of CKD (via albuminuria screening and eGFR monitoring) are critical for reducing progression and complications.The aim of this study was to identify the major barriers to the implementation of the nephrology care within Coordinated Care Model from the perspective of physicians working in primary care settings in Poland.A cross‑sectional CAWI (Computer‑Assisted Web Interview) survey was conducted among physicians who are members of primary care teams potentially eligible to implement the nephrology pathway under CC. The questionnaire covered five main sections: general information on pathways and CKD screening, implementation and functioning of the nephrology pathway, collaboration with nephrologists and coordination of care, training and needs for improvement, and barriers to initiation of the nephrology pathway. At least 240 physicians from various PC clinics across Poland participated.Among responding physicians, common reported barriers included: limited time in PC consultations, insufficient collaboration with nephrologists, lack of awareness of the pathway criteria among staff, inadequate or independent access to screening tests (e.g., UACR, eGFR). Additionally, many physicians from PC facilities with the neurology pathway implemented, reported that only a small proportion of their CKD‑risk patients underwent screening or complex consultations as part of the pathway.The study highlights that while the nephrology care has been formally introduced, its actual uptake in primary care remains low. Barriers span organisational, educational, logistical and patient‑related domains. Interventions to improve uptake may include streamlined screening procedures, enhanced training for PC teams, improved referral and consultation with nephrology specialists, and patient education on CKD risk.Addressing the identified barriers is critical to increasing the utilisation of the nephrology pathway under coordinated care in primary care settings. Strengthening implementation may lead to earlier CKD detection, more timely specialist involvement and ultimately better outcomes for patients.

CKM syndrome integrates metabolic, renal, and cardiovascular risk, yet population-level data in Europe remain scarce. This study examines its prevalence in Lithuanian adults.Cardiovascular diseases (CVD) and chronic kidney disease (CKD) are major health burdens, closely linked through shared pathophysiological mechanisms [1–4]. The recently defined CKM syndrome integrates metabolic risk factors, CKD, and cardiovascular involvement into a single pathophysiological spectrum [5–7]. Despite growing recognition, CKM prevalence data in Europe remain limited. This study aimed to estimate CKM syndrome prevalence in Lithuanian adults.Health records of 923,329 adults aged ≥40 years from the national Electronic Health Services and Cooperation Infrastructure Information System (ESPBI IS) were analysed. CKM-associated conditions included prediabetes or type 2 diabetes (T2D), obesity, and CKD. Cardiovascular outcomes included atherosclerotic cardiovascular disease (ASCVD), peripheral vascular disease, stroke, heart failure (HF), and atrial fibrillation (AF). CKM stages were classified as follows: Stage 0 – no CKM conditions; Stages 1–3 – ≥1 CKM-associated condition; Stage 4 – ≥1 cardiovascular diagnosis (incl. ASCVD).As of January 1, 2024, 1,531,303 Lithuanian residents were aged ≥40 years; 923,329 had health data in ESPBI IS. Mean age was 66.9 years, 59.1% were men. Overall, 23.4% met criteria for CKM stages 1–3, and 34.8% for stage 4. HF (25.4%) and AF (14.0%) were the most common CVD diagnoses. Obesity (21.2%) was the most frequent CKM-associated condition, followed by T2D (17.2%) and CKD (5.5%).This study demonstrates a high prevalence of CKM syndrome in Lithuanian adults, particularly at advanced stages. Frequent early CKM drivers such as obesity, T2D, and CKD likely contribute to progression toward CVD. The stage distribution observed in this large national cohort aligns with patterns seen in other European populations experiencing high metabolic and cardiovascular disease burdens. These findings provide important baseline data for understanding CKM syndrome in the region.This nationally representative study shows a high prevalence of CKM syndrome in Lithuanian adults, with many already in advanced stages. The distribution of CKM-related conditions provides essential baseline data for future public health and risk-stratification initiatives.