Cardiovascular-Kidney-Metabolic Comorbidities in Children: From Mechanisms to Lifelong Management

Pediatric cardiovascular health is increasingly recognized as a lifelong determinant of adult well-being. Over recent decades, a growing body of evidence has established that cardiovascular, kidney, and metabolic conditions do not arise in isolation but share overlapping pathophysiological roots that manifest early in life and compound in severity across the developmental continuum. The concept of cardiovascular–kidney–metabolic (CKM) syndrome, formally defined by the American Heart Association in 2023, provides an integrated framework to capture the bidirectional crosstalk among obesity, insulin resistance, hypertension, dyslipidemia, and chronic kidney disease. Although originally characterized in adult populations, CKM syndrome is now increasingly recognized as a pediatric problem with origins in early childhood or even the prenatal period.The epidemiological burden in children is already substantial. Studies across diverse cohorts report that more than one-quarter of children and adolescents present with two or more cardiometabolic risk factors simultaneously, and childhood body mass index trajectories project a continued surge in the co-occurrence of obesity, elevated blood pressure, and metabolic disturbances in the coming decades. Crucially, these risk factors do not simply coexist: childhood obesity drives early-onset hypertension and dyslipidemia, while accumulating evidence links subtle kidney function abnormalities — including microalbuminuria and mildly reduced glomerular filtration — to adverse cardiovascular remodeling even in pediatric populations. This multi-organ clustering underscores the need to move beyond single-disease paradigms toward an integrated CKM perspective in children.Recent advances have begun to illuminate the mechanistic underpinnings of pediatric CKM syndrome. Shared pathophysiological pathways include chronic low-grade inflammation, oxidative stress, renin–angiotensin–aldosterone system (RAAS) activation, ectopic lipid deposition, and gut microbiota dysbiosis — all of which converge to promote concurrent vascular, renal, and metabolic injury. Developmental programming further amplifies these risks: adverse intrauterine exposures, including gestational diabetes, maternal obesity, and preterm birth, epigenetically prime offspring toward accelerated CKM trajectories. Transcriptomic, proteomic, and metabolomic studies have begun to identify early molecular signatures of CKM risk, offering the prospect of biomarker-guided screening and targeted intervention before overt organ damage occurs. At the same time, artificial intelligence and advanced imaging modalities are emerging as powerful tools for integrating multidimensional risk data and enabling precision risk stratification in pediatric cohorts.Despite these advances, critical gaps remain. The natural history of pediatric CKM syndrome — from early metabolic dysfunction through progressive cardiovascular and renal injury into adulthood — remains incompletely characterized. Evidence-based strategies for primordial and primary prevention, early risk stratification, and long-term surveillance in children are lacking. Furthermore, health disparities in CKM burden and access to care across socioeconomic, geographic, and demographic groups remain inadequately addressed. Bridging these gaps requires coordinated research that integrates epidemiology, mechanistic biology, and clinical innovation within a unified CKM framework.Goal This Research Topic aims to consolidate innovative research that bridges epidemiology, pathophysiology, and clinical management to advance understanding of CKM syndrome in children and adolescents. The central goal is to foster an integrated perspective that connects population-level risk patterns with shared mechanistic pathways and evidence-based interventions, ultimately guiding clinicians toward more effective, individualized, and equitable care for children across their lifespan.Scope and Information for Authors This Research Topic focuses on CKM syndrome and its component conditions in pediatric populations. We encourage submissions that explore the burden, origins, trajectories, mechanisms, and management of cardiovascular, kidney, and metabolic comorbidities in children, including but not limited to the following areas:• Epidemiology and burden of CKM syndrome in children and adolescents, including multimorbidity clustering, risk factor co-occurrence, and population-based trajectory analyses.• Shared pathophysiological mechanisms linking cardiovascular, kidney, and metabolic conditions in pediatric populations, including chronic inflammation, oxidative stress, RAAS dysregulation, ectopic lipid accumulation, and gut microbiota–host interactions.• Developmental programming and early-life origins of CKM risk, including the role of gestational exposures, preterm birth, and epigenetic modifications in shaping long-term cardiometabolic and renal trajectories.• Cardiometabolic risk factors in pediatric obesity, hypertension, dyslipidemia, and insulin resistance, and their interplay with early kidney dysfunction and cardiovascular remodeling.• Primordial and primary prevention strategies, including lifestyle, nutritional, and pharmacological interventions targeting CKM risk factors in children and adolescents.• Early detection and risk stratification, including novel biomarkers, omics technologies, advanced imaging, and artificial intelligence applications for identifying children at elevated CKM risk.• Long-term outcomes and surveillance protocols for children with established CKM comorbidities, including cardiovascular, renal, and metabolic endpoints tracked across the developmental continuum into adulthood.• Health disparities and equity in pediatric CKM burden and access to prevention and management, including the influence of socioeconomic, geographic, and demographic factors.• Translational studies bridging mechanistic insights from basic science to clinical applications, including the development of targeted therapies and precision medicine approaches for pediatric CKM syndrome.We welcome original research articles, systematic reviews and meta-analyses, narrative reviews, brief research reports, and perspectives that contribute to advancing the understanding, prevention, and management of CKM syndrome in children and adolescents. Topic editors: Bowen Du, Jian Wang Source: https://www.frontiersin.org/research-topics/81304/cardiovascular-kidney-metabolic-comorbidities-in-children-from-mechanisms-to-lifelong-management