In order to appreciate and define the role of nephrologists in the newly defined cardio-kidney metabolic (CKM) syndrome, we acknowledge the important shift that must occur from a specialty that has traditionally focused on treating people with organ failure, to one that needs to now embrace the concept of prevention, early diagnosis, and delay of progression as complimentary to historical roles as providers of dialysis and transplantation. We describe the value that nephrology can play in further refining the CKM model to acknowledge the importance of the diagnostic precision of CKD, and kidney outcomes, and question the linearity of the model, given the complexities of CKD and CVD.