Expert consensus for primary care: assessing and treating heart, kidney, liver and metabolic health together (CKLMS, fatty liver/MASLD)

In short: Cardiovascular disease, kidney impairment, fatty liver (MASLD) and metabolic problems such as diabetes and overweight are closely linked. A group of experts proposes assessing and treating them together in the family doctor’s practice. What is new is that the liver is a fixed part of it: a simple score calculated from routine blood tests (FIB-4) shows whether liver scarring is likely. They call the concept CKLMS (cardiovascular–kidney–liver–metabolic syndrome) ¹.

Status of the evidence: This is a consensus statement by experts, not a systematic analysis of studies. The recommendations arose from two expert meetings in 2024 and 2025. Submitted 14 January 2026, accepted 20 April 2026, published online 28 April 2026 (European Journal of Internal Medicine 150, 2026). Article written on 4 October 2026. Newer guidelines and studies are not covered.

What is this about?

Heart, kidneys, liver and metabolism influence each other. Typical shared causes are belly fat, insulin resistance, high blood pressure and raised blood fats. Specialists often treat these areas separately. In practice, however, affected people first come to the family doctor. The liver has rarely been considered there so far, although fatty liver raises the risk of heart attack and kidney impairment ¹.

What does the proposal look like?

In the family doctor’s practice, six areas are to be checked with simple, available tests:

1. Blood pressure: Office measurement, and if possible home or 24-hour measurement.
2. Blood fats: Total, HDL and LDL cholesterol.
3. Kidney: Kidney function (eGFR) and protein in the urine (albumin-creatinine ratio).
4. Liver: FIB-4, from age, liver values and platelets.
5. Sugar: Fasting blood glucose or HbA1c.
6. Weight: BMI and waist circumference.

What applies to the liver?

For FIB-4: below 1.30 is low risk, 1.30 to 2.67 is unclear, above 2.67 is high risk. An unclear or high value is followed by a liver stiffness measurement (elastography). People with a low value are re-checked every 1 to 3 years. At high risk (FIB-4 above 2.67), the consensus recommends referral to a liver specialist. As treatment it names lifestyle first (weight, exercise, less alcohol) and treatment of related conditions, for example with GLP-1 drugs, SGLT2 inhibitors or statins. Resmetirom has been approved in the EU since August 2025 for MASH without cirrhosis ¹.

When to refer?

The family doctor remains the coordinator. Urgent referral applies, for example, to hypertensive emergencies or rapidly falling kidney function. Routine referral applies to values that are hard to control or complex conditions.

Where are the limits?

The recommendations rest on expert opinion and existing guidelines, not on a study of their own. Whether this approach produces better results in everyday care was not tested. The meetings were sponsored by a company, and several authors report consulting fees from pharmaceutical companies. They used AI for writing and proofreading help and checked the content themselves ¹.

What does this mean for me?

If you have high blood pressure, diabetes, overweight or kidney problems, also ask about your liver (FIB-4) at your family doctor. The values can usually be calculated from a normal blood test. Whether and how to treat is decided by your doctor.

This article does not replace medical advice.