Learning About Cardiovascular-Kidney-Metabolic Syndrome

Cardiovascular-kidney-metabolic (CKM) syndrome is a term that describes how problems with your heart, kidneys, and metabolism are connected. When one of these systems isn't working well, it can affect the others.

Looking at all three together helps you and your doctor find ways to prevent or treat health problems earlier, instead of focusing on just one condition. This can help protect your overall health because your heart, kidneys, and metabolism all work together.

• Your heart pumps blood to every organ in the body, including your kidneys.
• Your kidneys filter waste and extra fluid from your blood, which helps control your blood pressure.
• Your metabolism is how your body turns food into energy. Excess body weight, high blood pressure, high blood sugar, or high cholesterol can damage both your heart and kidneys over time.

Health problems like being overweight or having obesity, diabetes, chronic kidney disease, or high blood pressure affect your whole body. That means if you have one of these health problems, or if you’re at a higher risk for one, your risk of developing another health problem also goes up.

Anyone can get CKM syndrome. In fact, experts think that 9 out of 10 people in the United States have at least one risk factor for CKM syndrome, such as:

• Obesity or being overweight, especially having excess body fat around the waist.
• High cholesterol.
• High triglycerides (a type of fat in your blood).
• High blood pressure.
• Kidney disease.
• Diabetes.

There may also be things in your environment that can raise your risk but that you may not be able to control. For example, not having access to healthy food, safe places to exercise, stable housing, or reliable healthcare can affect your heart, kidneys, and metabolic health. These things in your environment are called social determinants of health.

Your doctor may be able to connect you with resources to help you take care of your health, such as food assistance programs, help with medical costs, and transportation to get to appointments. If you don’t have a doctor, try to find free or low-cost clinics in your community.

Doctors talk about CKM syndrome in five stages, from stage 0 (no risk factors) to stage 4 (several risk factors). The good news is that with the right lifestyle changes and treatment, it’s possible to move backward to a healthier stage.

The five stages of CKM syndrome are:

• Stage 0: No risk factors. You’re at a weight that’s healthy for you. Your blood sugar, cholesterol, and blood pressure are in a normal range, and your kidneys are working as they should.
• Stage 1: Excess weight. You have extra body fat, especially around the waist. You might also have prediabetes (an early stage of type 2 diabetes that’s reversible with treatment). But you don’t have any other health problems yet.
• Stage 2: Metabolic risk factors or kidney disease. You have one or more health problems like high blood pressure, type 2 diabetes, high cholesterol or triglycerides, or early kidney disease. But there are no signs of heart disease yet.
• Stage 3: Early heart or kidney damage. Your heart and kidneys are showing signs of damage, even though you might not feel it. At this stage, you’re at a high risk for heart disease and other metabolic health problems.
• Stage 4: Heart disease with CKM syndrome risk factors. At this stage, you’ll have clear symptoms of CKM syndrome. You might have had a heart attack, heart failure, stroke, or other heart disease. You might also have kidney disease or other metabolic health problems.

Keep in mind that you might not have any symptoms during the early stages of CKM syndrome. That means getting regular health checkups is the best way to find and treat problems before they get worse.

Doctors can do different tests to find out if you have risk factors for CKM syndrome. Not everyone will need every test. It depends on your personal health, your family health history, and whether you have symptoms.

If you don’t have any symptoms of a health problem, your doctor will check your weight and blood pressure at your yearly checkup. They might also do a blood test to look at your blood sugar, cholesterol, triglycerides, kidney function, and other things that can tell them about your overall health. If those tests show signs of a problem, your doctor may do more detailed tests to make a diagnosis and work with you on a treatment plan.

Treatment for CKM syndrome depends on your health and risk factors. Work with your doctor to make a plan that is right for you. Your treatment plan may include healthy life changes, medicines, or both.

Healthy habits are the best way to prevent CKM syndrome or to keep it from getting worse. Even small changes can have a big impact. Consider these strategies:

• Aim for a healthy weight. If you’re at a higher weight, losing even 5% to 10% of your body weight (for example, 10 to 20 pounds if you weigh 200 pounds) can improve your blood pressure, blood sugar, cholesterol, and kidney health. Talk with your doctor about what’s a healthy weight for you and how they can support you in reaching your weight loss goals.
• Eat heart-healthy foods. Include fresh or frozen fruits and vegetables, whole grains, lean proteins, and healthy fats. Try to limit salt, added sugars, and processed foods.
• Move your body as much as possible. Aim for at least 150 minutes per week of moderate physical activity (like brisk walking, swimming, or dancing). Even everyday activities like housework and gardening count. If 150 minutes a week seems out of reach, start small. Any amount of activity is better than none.
• Get enough sleep to feel well-rested. In general, aim for 7 to 9 hours per night on a regular schedule. Talk to your doctor if you snore loudly or feel very tired during the day. You may need to be checked for sleep apnea.
• Find healthy ways to manage stress. Stress is part of life, but chronic stress can affect your heart, blood sugar, and blood pressure. Try to find ways to help lower stress, such as physical activity, relaxation techniques, or talking with a counselor.
• If you smoke, vape, or use other tobacco or nicotine products, try to quit. Avoiding these products is one of the best things you can do for your health. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good.

Depending on your health and your risk factors for CKM syndrome, your doctor may also recommend medicines. Some of them can treat more than one health problem at a time.

• SGLT2 inhibitors, like empagliflozin or dapagliflozin, help remove extra sugar and fluid through your urine. They can also protect your heart and kidneys.
• GLP-1 medicines, like semaglutide or tirzepatide, can lower your blood sugar, support weight loss, and protect your heart.
• Blood pressure medicines, like ACE inhibitors or ARBs, can lower your blood pressure and help protect your kidneys.
• Finerenone, a non-steroidal MRA, can help protect the heart and kidneys if you have both diabetes and kidney disease.
• Statins can treat high cholesterol and help lower your risk of heart disease.