The cardiovascular–kidney–metabolic staging in type 2 diabetes: the clock starts ticking early

Nishizawa et al. demonstrate that cardiovascular–kidney–metabolic (CKM) staging is a strong predictor of all-cause mortality in type 2 diabetes, even before contemporary ardiorenal therapies were widely available. In their cohort, mortality rose sharply from stage 3 onward, underscoring that pathological risk begins well before overt cardiorenal failure. Because CKM staging relies on routine clinical data, it offers a pragmatic framework for early risk stratification, yet it is often applied too late. Integrating CKM assessment into electronic health systems and initiating cardiorenalprotective interventions in stages 1–2 could substantially improve outcomes. Future studies should validate CKM staging in modern therapy settings and evaluate stageguided interventions.