CKM Syndrome: Defining the Link Between Heart Disease, Kidney Disease, Obesity & Diabetes

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There's so much to think about when it comes to our health that we tend to simplify things by considering each component of it individually.

You know you need to keep up with your diet, your exercise regimen and your overall mental health. You also need to do something about those achy joints, and you need to make time for screenings, like the colonoscopy you're due for or your annual mammogram. And monitoring specific health details — your weight, blood pressure, cholesterol levels — is important, too.

"We sometimes think about diseases in silos, but, in reality, everything in the body is very interconnected," explains Dr. Sadeer Al-Kindi, a preventive cardiologist at Houston Methodist. "For instance, the heart, kidneys and endocrine system — all of these biological systems influence one another."

In other words, when something is wrong with one system, it can lead to problems in another.

And the links between these can be strong, as is the case for heart disease, kidney disease and metabolic issues. So much so that the American Heart Association (AHA) has defined an entirely new condition to represent the overlap between them, called CKM syndrome.

The connection between heart disease, kidney disease and metabolic conditions

You've heard of heart disease and kidney disease, though you may not be aware of what one has to do with the other. The term "metabolic condition" might not sound immediately familiar, but you certainly know of its two most prominent examples, type 2 diabetes and obesity.

All of these health problems are linked.

Your heart supplies blood to every organ in your body. Your kidneys filter every ounce of blood your heart pumps. Damage within either of these organs leads to strain on the other. So do changes in pressures and hormone signaling, whether that's from high blood pressure, high blood sugar or fat deposition within or around these organs.

"Heart disease can lead to kidney disease. Kidney disease can lead to heart disease," says Dr. Al-Kindi. "And, often, the issues really start as problems with weight — though you can have kidney disease or heart disease without being significantly overweight."

It's complex, to say the least, with bidirectional effects existing between all of these common health conditions.

"That's why it makes sense to lump them all together, rather than think about each disease separately," adds Dr. Al-Kindi. "We need to think about each of these as one avenue within the same disease landscape."

Cue the AHA's establishment of CKM syndrome, which stands for cardiovascular-kidney-metabolic syndrome.

What is CKM syndrome?

CKM syndrome is defined as the overlap that exists between obesity, type 2 diabetes, chronic kidney disease and heart disease. Having the syndrome increases a person's risk of developing heart disease, a leading cause of death in the U.S.

But that's not the whole story. Each component of CKM syndrome can influence a person's risk of developing another. CKM syndrome can also affect other organs in the body, including the brain and liver.

"CKM syndrome is not something new per se, it's just a formalization of what have learned over the years," says Dr. Al-Kindi. "The benefit of formalizing things in this way is that it enables a structured, holistic way of thinking about these intertwined conditions. It also informs how we not only stage a person's risk but how we guide treatment."

What are the stages of CKM syndrome?

The AHA defined five CKM stages, numbered 0 through 4:

  • Stage 0: No CKM risk factors present
  • Stage 1: Abdominal obesity and/or prediabetes
  • Stage 2: Metabolic conditions (Type 2 diabetes, high blood pressure and high triglycerides) or kidney disease
  • Stage 3: Early heart disease in people with obesity or other metabolic conditions (Type 2 diabetes, high blood pressure and high triglycerides) or kidney disease
  • Stage 4: Heart disease in people with obesity, other metabolic conditions (Type 2 diabetes, high blood pressure and high triglycerides) or kidney disease

"The stages help us think about everything from obesity — as a risk factor, but also as something we should tackle with lifestyle changes, medications or even surgery — all the way up to how we treat someone who has several of these interlinked health issues, heart disease, obesity and kidney disease, for example."

With effective treatments now existing for each, physicians can now think of treatment in a more holistic manner. Staging also helps guide prevention and therapeutic strategies, placing structure around the steps needed to keep CKM from progressing.

"We have interventions — behavioral, medical and surgical — that can be applied across the spectrum of CKM syndrome, all the way from stage zero to four," says Dr. Al-Kindi. "So, it's a way to help us improve population health in general, but also improve health outcomes at the personal level."

He adds that early stages can often be managed by a primary care doctor, but, if allowed to progress, the later stages of CKM syndrome typically require one or more specialists.

"The hope is that with the formalization of CKM syndrome, a more interdisciplinary-care model will develop and help bring together specialists across these disciplines — endocrinology, obesity, nephrology, cardiology," adds Dr. Al-Kindi. "But tackling these challenges will require more than just physicians. Policy change, community engagement and even psychological interventions are needed to reduce the prevalence of CKM syndrome."

How to prevent CKM syndrome, or keep it from progressing

The connection between these conditions might be complex, but, fortunately, how to prevent and slow the progression of CKM syndrome isn't. Heart disease, kidney disease, metabolic conditions — they all share similar risk factors.

"Of course, there are some factors unique to kidney disease, unique to heart disease, unique to diabetes," says Dr. Al-Kindi. "But the lifestyle behaviors and medical underpinnings that help improve these conditions are the same. The AHA calls them 'Life's Essential 8.'"

The AHA's Essential 8 are to:

  • Eat healthy
  • Be physically active
  • Don't smoke, and stop smoking if you do smoke
  • Get quality sleep
  • Keep a healthy weight
  • Manage cholesterol levels
  • Manage blood sugar
  • Manage blood pressure

These behaviors have an impact on more than CKM syndrome. They can help improve a number of health conditions," adds Dr. Al-Kindi. "They are essentially a recipe for healthy aging — not just extending lifespan but improving the quality of that lifespan as well."

Oct. 23, 2023