{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:19:25Z","timestamp":1785410365542,"version":"3.56.0"},"reference-count":16,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Boehringer Ingelheim","award":["SAG 11381"],"award-info":[{"award-number":["SAG 11381"]}]},{"award":["SAG 11381"],"award-info":[{"award-number":["SAG 11381"]}],"id":[{"id":"https:\/\/ror.org\/05kffp613","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Chronic kidney disease (CKD) and cardiovascular disease (CVD) confer a substantial, interrelated health burden. CKD markedly increases cardiovascular risk and premature mortality, while CVD accelerates kidney disease progression. Despite the availability of simple diagnostic tests and validated CVD risk tools, CKD screening remains inconsistent, kidney measures are under-integrated into CVD risk stratification, and guideline-recommended screening is variably adopted due to system-, clinician-, and patient-level barriers. This initiative aimed to develop a consensus-based, practical algorithm to integrate CKD screening into CVD risk management. Methods: A structured Delphi process was used to develop an evidence-informed, consensus-based screening algorithm. In Phase 1, a multidisciplinary expert panel completed iterative surveys to identify and prioritize key screening components and achieve preliminary consensus. Participants received a landscape assessment summarizing current practices, evidence, and implementation gaps. A roundtable discussion reviewed clinical guidelines, published evidence, and survey findings, informing the development of an initial algorithm draft. In Phase 2, a follow-up roundtable refined the algorithm, assessed feasibility within real-world clinical workflows, and confirmed consensus on priority elements. Agreement was finalized through structured group discussion and survey-based validation. Results: Panel discussions identified optimal CKD screening triggers, key gaps in current practice, and opportunities to promote earlier identification of at-risk patients. Refinement during the second roundtable resulted in consensus on algorithm structure, content, and applicability across settings. The final algorithm reflects a streamlined, implementation-focused approach to support consistent and earlier identification of at-risk patients. Conclusions: The algorithm, labeled the Primary Care Cardio-Kidney Risk Navigator, provides a practical, flexible framework that integrates and operationalizes existing guideline recommendations into a unified, workflow-oriented approach for primary care that supports consistent real-world implementation. It supports earlier identification, referral, and prevention strategies for at-risk populations and can be implemented within electronic health records or as a standalone clinical decision support tool.<\/jats:p>","DOI":"10.3390\/jcm15145379","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:16:22Z","timestamp":1783592182000},"page":"5379","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a Primary Care Cardio-Kidney Risk Navigator for Clinical Decision Support"],"prefix":"10.3390","volume":"15","author":[{"given":"Tyler J.","family":"Gluckman","sequence":"first","affiliation":[{"name":"Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, Providence Health System, Portland, OR 97225, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7619-2657","authenticated-orcid":false,"given":"Kade","family":"Birkeland","sequence":"additional","affiliation":[{"name":"Research Data Services, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankeet","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, CA 94588, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9616-1946","authenticated-orcid":false,"given":"Matthew Jay","family":"Budoff","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Harbor-UCLA Medical Center, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Colby","family":"Danna","sequence":"additional","affiliation":[{"name":"Department of Primary Care, Veterans Southeast Louisiana Healthcare System, New Orleans, LA 70119, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihar R.","family":"Desai","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, New Haven, CT 06520-8017, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Norfolk","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Geisinger Health, Danville, PA 17822, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0425-120X","authenticated-orcid":false,"given":"Ahlam","family":"Elbedewe","sequence":"additional","affiliation":[{"name":"Care Delivery, Petauri Kinect, New York, NY 10001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Kiernan","sequence":"additional","affiliation":[{"name":"Care Delivery, Petauri Kinect, New York, NY 10001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha","family":"Pachpor","sequence":"additional","affiliation":[{"name":"Care Delivery, Petauri Kinect, New York, NY 10001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9571-1275","authenticated-orcid":false,"given":"Jamie","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Cardiometabolic Health, Premium Health, Brooklyn, NY 11201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2026, January 02). Screening for Chronic Kidney Disease, Available online: https:\/\/www.cdc.gov\/kidney-disease\/hcp\/ckd-screening\/index.html."},{"key":"ref_2","unstructured":"National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2026, January 07). USRDS 2025 Annual Data Report, Available online: https:\/\/usrds-adr.niddk.nih.gov\/2025."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","author":"Eknoyan","year":"2024","journal-title":"Kidney Int."},{"key":"ref_4","unstructured":"American Heart Association (2026, January 02). Heart Disease and Stroke Statistics\u20142024 Update: At-a-Glance. Available online: https:\/\/www.heart.org\/-\/media\/PHD-Files-2\/Science-News\/2\/2024-Heart-and-Stroke-Stat-Update\/2024-Statistics-At-A-Glance-final_2024.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1016\/j.jacc.2024.08.006","article-title":"Bidirectional relationship between kidney disease progression and cardiovascular events in type 2 diabetes","volume":"84","author":"Neuen","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e099966","DOI":"10.1136\/bmjopen-2025-099966","article-title":"Screening programmes for early detection of chronic kidney disease in the USA and other English-speaking countries (Canada, Australia and UK): A systematic literature review","volume":"15","author":"Kushner","year":"2025","journal-title":"BMJ Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1161\/01.cir.0000437741.48606.98","article-title":"2013 ACC\/AHA guideline on the assessment of cardiovascular risk","volume":"129","author":"Goff","year":"2014","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e010763","DOI":"10.1161\/CIRCOUTCOMES.123.010763","article-title":"PREVENT equations: A new era in cardiovascular disease risk assessment","volume":"17","author":"Razavi","year":"2024","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_9","unstructured":"Mount Sinai (2026, January 02). Current Heart Attack Screening Tools Are Not Optimal and Fail to Identify Half the People Who Are at Risk. Available online: https:\/\/www.mountsinai.org\/about\/newsroom\/2025\/current-heart-attack-screening-tools-are-not-optimal-and-fail-to-identify-half-the-people-who-are-at-risk?."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"21501319251358923","DOI":"10.1177\/21501319251358923","article-title":"Closing gaps in chronic kidney disease detection: Evaluating at-home targeted testing in a safety-net population","volume":"16","author":"Schultz","year":"2025","journal-title":"J. Prim. Care Community Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1053\/j.ajkd.2024.09.016","article-title":"The new cardiovascular-kidney-metabolic (CKM) syndrome: An opportunity for CKD detection and treatment in primary care","volume":"85","author":"Rumrill","year":"2025","journal-title":"Am. J. Kidney Dis."},{"key":"ref_12","unstructured":"American Heart Association (2026, June 26). Understanding Staging for Cardiovascular-Kidney-Metabolic Syndrome (CKM Syndrome). Available online: https:\/\/www.heart.org\/-\/media\/Files\/Health-Topics\/CKM\/CKM-Staging.pdf?sc_lang=en."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1093\/eurheartj\/ehaf167","article-title":"Cardiovascular disease in chronic kidney disease","volume":"46","author":"Cherney","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1161\/CIRCULATIONAHA.120.050686","article-title":"Cardiovascular disease in chronic kidney disease: Pathophysiological insights and therapeutic options","volume":"143","author":"Jankowski","year":"2021","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"SP157","DOI":"10.37765\/ajmc.2025.89711","article-title":"Reducing care fragmentation to boost CKM disease outcomes","volume":"31","author":"Johnson","year":"2025","journal-title":"Am. J. Manag. Care"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"American Diabetes Association (2024). Standards of care in diabetes\u20142025. Diabetes Care, 48, S1\u2013S352.","DOI":"10.2337\/dc25-SDIS"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5379\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T04:16:43Z","timestamp":1783743403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":16,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145379"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145379","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}