Authors

• Waleed Alhabeeb, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi ArabiaFollow
• Abdulhalim J. Kinsara, Department of Adult Cardiology, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
• Ahmed Mitwalli, Department of Internal Medicine/Nephrology, King Saud University, Riyadh, Saudi Arabia
• Ali A. Alshehri, Obesity, Endocrine & Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
• Faisal Aba-Alkhail, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
• Ismail Raslan, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
• Khalid Aljohani, Department of Interventional Cardiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
• Mohammed Arafah, Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
• Muthana Sahlawi, Department of Internal Medicine, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
• Saud Alsifri, Department of Endocrinology, Alhada Armed Forces Hospital, Taif, Saudi Arabia
• Suleiman M. Kharabsheh, CCU and Telemetry Units, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Saudi Heart Association Scientific Statement on Cardiovascular–Kidney–Liver-Metabolic (CKLM) syndrome

Abstract

Background: Cardiovascular, kidney, metabolic, and liver diseases are closely interconnected and frequently coexist. While the cardiovascular–kidney–metabolic (CKM) framework provides a unified model, increasing evidence supports a central role for hepatic disease, particularly metabolic dysfunction–associated steatotic liver disease (MASLD), in this continuum. The Saudi Heart Association (SHA) therefore aimed to introduce the cardiovascular–kidney–liver–metabolic (CKLM) syndrome as an expanded framework and provide expert guidance on its pathophysiology, staging, screening, and management, with relevance to the Saudi population.

Methods: A multidisciplinary expert panel convened under the auspices of the SHA conducted a comprehensive, non-systematic literature review and developed consensus-based recommendations through iterative discussion and critical appraisal of the evidence.

Results and conclusions: CKLM syndrome is a progressive multisystem disorder driven by shared mechanisms, including insulin resistance, inflammation, and fibrosis, with bidirectional interactions across cardiovascular, kidney, metabolic, and hepatic domains. A stage-based framework is proposed to support risk stratification and guide management. Therapeutic strategies include agents with established cardiovascular, kidney and metabolic benefits, with emerging evidence supporting combination approaches. The high prevalence and coexistence of CKLM-related conditions in Saudi Arabia highlight the need for integrated care. The CKLM framework extends existing models by incorporating hepatic disease into the cardiometabolic–kidney continuum, enabling a more comprehensive approach to risk assessment and management. Multidisciplinary, stage-based strategies are recommended as they are expected to improve outcomes, although further validation is required.

Recommended Citation

Alhabeeb, Waleed; Kinsara, Abdulhalim J.; Mitwalli, Ahmed; Alshehri, Ali A.; Aba-Alkhail, Faisal; Raslan, Ismail; Aljohani, Khalid; Arafah, Mohammed; Sahlawi, Muthana; Alsifri, Saud; and Kharabsheh, Suleiman M. (2026) "Saudi Heart Association Scientific Statement on Cardiovascular–Kidney–Liver-Metabolic (CKLM) syndrome," Journal of the Saudi Heart Association: Vol. 38 : Iss. 2 , Article 23.
Available at: https://doi.org/10.37616/2212-5043.1510

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