Clinical Report: Retraction and Replacement Notice on Advanced CKM Syndrome

Overview

The authors requested retraction and replacement of their original report after an audit identified coding errors in the classification of advanced cardiovascular-kidney-metabolic (CKM) syndrome. Correcting the PREVENT risk threshold and the stage 0 anthropometric rule reduced the survey-weighted prevalence of advanced CKM syndrome from 40.0% to 15.8%; the corrected analysis retained the principal finding of associations with several social risk factors, with variation across racial and ethnic groups and sexes.

Background

CKM syndrome describes the interconnected burden of cardiovascular, kidney, and metabolic dysfunction, and the source article examines how social risk factors relate to advanced disease. Accurate stage classification is important to the descriptive and regression analyses reported in this study. The authors identified a scale mismatch in the PREVENT threshold and an incorrect logical operator in the stage 0 anthropometric classification. They reran the analyses and replaced the original article with corrected results.

Data Highlights

Key Findings

• The intended stage 3 high–10-year cardiovascular disease risk threshold was at least 20% on a 0%–100% PREVENT scale. Code had applied 0.2, treating values of 0.2% or higher as meeting the threshold; the corrected code applies 20.
• Stage 0 classification was corrected to require both BMI and waist circumference to be within the normal range, rather than accepting either measure alone.
• The corrected workflow identified 34 participants without CKM stage data, who were excluded, reducing the cohort from 28,218 to 28,184.
• Corrected results classified 5,879 participants as having advanced CKM syndrome and estimated a survey-weighted prevalence of 15.8%, compared with 12,614 participants and 40.0% in the original report.
• The corrected findings continued to associate advanced CKM syndrome with several social risk factors, with associations differing across racial and ethnic groups and between sexes. Poor neighborhood or built environment was supported in all four race and ethnicity groups; poor social or community context was not supported in the other race and ethnicity group.
• In fully adjusted models, limited health care access was supported only among non-Hispanic Black adults in race-stratified analyses and was not supported in either sex-stratified model. Significant age interactions were reported for economic stability, neighborhood or built environment, and social or community context, but not for education access or health care access.

Clinical Implications

The notice documents that the original stage 3 threshold substantially overclassified advanced CKM syndrome and that corrected prevalence and subgroup results should be taken from the replacement analysis. The authors report that the principal association between advanced CKM syndrome and several social risk factors remains, while selected secondary and subgroup interpretations changed.

Conclusion

The retraction and replacement followed a comprehensive audit and correction of two CKM classification errors. The corrected analysis substantially lowers the estimated burden of advanced CKM syndrome while retaining the study’s principal interpretation of social risk factor associations, with specified subgroup differences.

Related Resources & Content

1. Ekwunife O et al., JAMA Network Open, 2026 -- Social Risk Factors and Disparities in Advanced Cardiovascular-Kidney-Metabolic Syndrome
2. American Heart Association, Professional Heart Daily, 2026 -- 2026 Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome
3. European Journal of Preventive Cardiology — Retraction and replacement of: Minimal extra-cardiac atherosclerosis present in young people with sudden cardiac death due to coronary artery disease
4. European Journal of Preventive Cardiology — Withdrawal and Substitution of: Impact of Inpatient versus Outpatient Cardiac Rehabilitation on Five-Year Outcomes in Acute Myocardial Infarction Patients
5. Frontiers in Endocrinology — Retraction: Comparison of triglyceride-glucose index and triglyceride-glucose related indexes in predicting cardiovascular disease incidence among populations with cardiovascular-kidney-metabolic syndrome stages 0-3: a nationwide prospective cohort study
6. 2026 Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome
7. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes | New England Journal of Medicine
8. 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines