The cardiovascular-kidney-metabolic framework recognizes the interconnected biological, clinical, and societal drivers of cardiovascular disease, chronic kidney disease, diabetes, and obesity. To advance an integrated perspective, aligned with the kidney community focus, the International Society of Nephrology convened an International Expert Forum, bringing together a global and multidisciplinary team of leaders in this field. This meeting report synthesizes key discussions spanning cardiovascular-kidney-metabolic risk stratification, lifestyle interventions, guideline-directed medical therapies, emerging late-stage therapeutics, and models of care delivery. Participants emphasized the importance of early, integrated case finding; long-term, joint kidney-cardiovascular risk assessment; and timely use of evidence-informed therapies to reduce kidney disease progression, kidney failure, and cardiovascular events. Persistent gaps, including therapeutic inertia, fragmented care, and global inequities in access to care, were highlighted, alongside promising multidisciplinary and system-level care models. Emerging therapies targeting residual risk further underscore the need for adaptive implementation strategies. Aligned with the International Society of Nephrology's mission, this forum represents a foundational step toward connecting disciplines, bridging evidence-to-practice gaps, and building global capacity to improve equitable cardiovascular-kidney-metabolic outcomes.

To realize their full potential in improving health outcomes, clinical guidelines must integrate methodological rigor with practical relevance and human impact. This paper is a work of advocacy and proposal for action. Drawing upon established research, emerging paradigms, and our collective experience as patients and researchers and our respective background in legal, governance and healthcare, we build a case that the systematic integration of lived experience - the unique, embodied knowledge held by patients and caregivers - is essential for guideline relevance and implementation. Distinct from, yet complementary to, clinical and methodological knowledge, this expertise answers "What is it like?" and "What matters?" Its integration refines topic selection, enriches evidence interpretation, shapes implementable recommendations, and sustains guidelines as living documents for shared decision-making. To move beyond ad hoc involvement, we propose a structured dual framework: a formal Patient and Public Engagement Policy and a sustainable Talent Pipeline for Lived Experience. The proposed four-stage pipeline (Discovery, Apprenticeship, Mastery, Stewardship) cultivates lived experience as a professional competency, embedding it from scoping through implementation and governance. A phased implementation plan (co-design, pilot, scale-up) is outlined to translate this framework into practice. While framed within the context of Kidney Disease: Improving Global Outcomes, the model is designed for adaptation by any guideline body. The proposed framework offers a structured, actionable, and adaptable method for operationalizing this knowledge, promoting equity, partnership, and guideline impact globally. We present it as a starting point for action and iterative learning, designed to be implemented, evaluated, and refined by the global kidney community and to ultimately deliver better patient lives.