Patients with chronic kidney disease (CKD) bear a disproportionate burden of cardiovascular (CV) morbidity and mortality, yet preventive strategies in clinical practice remain remarkably conservative and largely therapy-centered. The 2024 KDIGO guideline on CKD evaluation and management advocates the systematic use of validated prediction equations for kidney failure and CV outcomes, while contemporary CV prevention guidelines endorse multivariable risk tools that incorporate kidney measures. However, neither nephrology nor cardiology guidance has yet translated this risk-based paradigm into operational, bedside algorithms that link quantified risk to specific treatment combinations or incorporate frailty, life expectancy, and polypharmacy into decision-making.
