From cardiovascular-kidney-metabolic syndrome to cardio-renal-hepatic-metabolic syndrome: a framework destined to expand further?

Cardiovascular-kidney-metabolic syndrome (CKM) represents an integrated clinical model describing the interaction among different organs and systems. Recent evidence suggests an expansion of this paradigm, including the liver as a relevant organ involved in systemic inflammatory and metabolic processes.Metabolic dysfunction-associated steatotic liver disease (MAFLD) is increasingly recognized as a component of the metabolic network, contributing to chronic inflammation and increased cardiovascular and renal risk. In this context, an extended model, referred to as cardio-renal-hepatic-metabolic syndrome (CRHM), has been proposed, reflecting a broader and more integrated view of this complex pathological condition.This framework currently represents an evolving pathophysiological hypothesis requiring further clinical validation.A future expansion of the multiorgan pathological network cannot be excluded, considering the shared pathophysiological mechanisms and their pleiotropic effects. An integrated approach may improve risk stratification and guide more personalized therapeutic strategies.