{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T16:07:11Z","timestamp":1773763631946,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Outpatient Department and in part by a research grant of Menarini to the Research Funds of the Medical Outpatient Department"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Before the American Heart Association introduced the cardiovascular\u2013kidney\u2013metabolic (CKM) syndrome concept in 2023, clinical care was largely organ-specific. This retrospective study analyzed diagnostic patterns and gaps in 406 patients with hypertension referred to and evaluated at the University Hospital Basel Hypertension Centre in 2017, 2019, or 2022 to identify blind spots in the assessment of cardio\u2013kidney\u2013liver\u2013metabolic health. Electronic health records were used to assess CKM-relevant diagnostics, including lipid profiles, N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography, kidney function (estimated glomerular filtration rate: eGFR, urinary albumin-to-creatinine ratio: uACR), and hepatic assessment (Fib-4 score, abdominal ultrasound). Previously undetected conditions were identified according to contemporary criteria for dyslipidemia, chronic kidney disease (CKD), suspected heart failure (HF), diabetes, and suspected metabolic dysfunction-associated steatotic liver disease (MASLD). Although 94% of participants had laboratory data, key CKM parameters were inconsistently assessed. Of the participants, 39% had neither NT-proBNP measurement nor echocardiography, and 27% lacked hepatic ultrasound or sufficient data for Fib-4 calculation. Previously unrecognized comorbidities were common (suspected HF 21%, CKD 6%, suspected MASLD 3%). Lipoprotein(a) testing increased from 0% in 2017 to 23.7% in 2022, indicating growing awareness. Despite specialized care, diagnostic fragmentation persisted, underlining the need for systematic, interdisciplinary screening and informing the design of prospective registries such as the Swiss CKLM Registry to integrate patient-centered cardio\u2013kidney\u2013liver\u2013metabolic care.<\/jats:p>","DOI":"10.3390\/life16030492","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:03:27Z","timestamp":1773756207000},"page":"492","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Whole Patient: Lessons from the Pre-CKM Era Toward Integrated Cardio\u2013Kidney\u2013Liver\u2013Metabolic Care"],"prefix":"10.3390","volume":"16","author":[{"given":"Felicia Chantal","family":"Derendinger","sequence":"first","affiliation":[{"name":"Medical Outpatient Department and Hypertension Center, ESH Hypertension Center of Excellence, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Faculty, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5188-1723","authenticated-orcid":false,"given":"Annina Salome","family":"Vischer","sequence":"additional","affiliation":[{"name":"Medical Outpatient Department and Hypertension Center, ESH Hypertension Center of Excellence, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Faculty, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1962-8186","authenticated-orcid":false,"given":"Michael","family":"Mayr","sequence":"additional","affiliation":[{"name":"Medical Outpatient Department and Hypertension Center, ESH Hypertension Center of Excellence, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Faculty, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lilian","family":"Sewing","sequence":"additional","affiliation":[{"name":"Medical Outpatient Department and Hypertension Center, ESH Hypertension Center of Excellence, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Faculty, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7591-4104","authenticated-orcid":false,"given":"Isabelle","family":"Arnet","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6373-9820","authenticated-orcid":false,"given":"Thilo","family":"Burkard","sequence":"additional","affiliation":[{"name":"Medical Outpatient Department and Hypertension Center, ESH Hypertension Center of Excellence, University Hospital Basel, 4031 Basel, Switzerland"},{"name":"Medical Faculty, University of Basel, 4031 Basel, Switzerland"},{"name":"Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","unstructured":"GBD 2019 Risk Factors Collaborators (2020). 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