You Don’t Want to Be a Part of This Threesome!
- Cardiovascular-kidney-metabolic (CKM) syndrome is a condition that happens when diabetes and kidney disease, heart issues, and metabolic troubles all become connected. When one problem gets worse, it puts more strain on the others.
- Risk factors include diabetes (primarily type 2 diabetes) hypertension, obesity, dyslipidemia, and chronic inflammation.
- Early diagnosis involves a combination of tests including blood pressure checks, cholesterol panels, and kidney function tests.
- Managing CKM syndrome and CKM treatment involves an integrated approach, addressing heart health, kidney protection, and metabolic control through lifestyle changes and medications like SGLT2 inhibitors and GLP-1 receptor agonists.
- Preventative measures like eating healthy, exercising regularly, maintaining a healthy weight, quitting smoking, and managing stress can help lower your risk and keep CKM syndrome from getting worse.
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Did you know that your heart and your kidneys are like a married couple? In sickness and in health, ‘til death do they part! This is especially true for people with diabetes.
People with diabetes – especially type 2 – often have multiple metabolic conditions like hyperglycemia (high blood sugar), hypertension (high blood pressure), obesity, and high cholesterol. These factors, in addition to conditions like inflammation, oxidative stress, and vascular dysfunction, form the basic abnormalities in heart and kidney disease. Together, these issues can lead to cardiovascular-kidney-metabolic (CKM) syndrome.
What Is Cardiovascular-Kidney-Metabolic Syndrome?
CKM syndrome is a condition where the heart, kidneys, and metabolic systems impact each other, creating a cycle where one condition makes the others worse.
For example, diabetes causes high blood sugar levels which can strain the heart and kidneys. Heart disease itself can also harm the kidneys, and poor kidney function can increase cardiovascular risks.
What Causes CKM Syndrome?
CKM syndrome is often triggered by underlying factors such as obesity, insulin resistance, hypertension, and chronic inflammation. Diabetes and kidney disease – along with these issues – can cause stress and damage to blood vessels and organs, leading to inflammation and poor function of the heart and kidneys.
CKM Syndrome Stages
CKM syndrome doesn’t happen all at once. Like many chronic conditions, it develops in stages, with symptoms gradually worsening. That’s why early identification of CKM syndrome symptoms is so important. Identifying these stages early can help guide CKM treatment and improve long-term outcomes.
- Stage 1: Risk factors begin to appear
- Stage 2: Metabolic dysfunction and early organ strain
- Stage 3: Advanced organ damage
- Stage 4: High-risk or end-stage disease
What Are the Risk Factors for CKM Syndrome?
Type 2 diabetes plays a central role in the development of CKM syndrome. CKM syndrome can happen in people with type 1 diabetes, but it’s much more common in people with type 2.
Risk factors include:
- Type 2 diabetes
- High blood pressure (hypertension)
- Obesity
- Dyslipidemia (abnormal levels of cholesterol and triglycerides)
- Smoking
- Chronic inflammation
- Sedentary lifestyle
- Family history
- Age
What Are CKM Syndrome Symptoms?
CKM syndrome often develops gradually, and people don’t have symptoms in the early stages. However, when symptoms do occur, they can vary depending on which systems are most affected.
Heart-Related Symptoms
Kidney-Related Symptoms
- Shortness of breath, especially during physical activity or while lying down
- Fatigue and weakness
- Swelling in the legs, ankles, or feet (edema)
- Chest pain or discomfort
- Irregular heartbeat or palpitations
- Swelling in the hands, feet, or face due to fluid retention
- Changes in urination (e.g., foamy urine, decreased urine output, or frequent urination)
- High blood pressure that’s hard to control
- Nausea, vomiting, or loss of appetite (in advanced stages)
Is CKM Syndrome Common?
Yes. CKM syndrome is more common than many people realize, especially among older adults and those with multiple cardiometabolic conditions. That means that people with diabetes should take note of the risks.
Recent research is beginning to reveal just how widespread the condition really is.
A 2024 study published in JAMA analyzed data from over 10,000 adults using the National Health and Nutrition Examination Survey (NHANES). The results were quite shocking:
- Nearly 90% of adults in the U.S. have CKM stage 1 or higher
- 15% of participants had more advanced stages of CKM syndrome
- The condition becomes more prevalent with age, especially among people 65 and older
- Black adults were found to have the highest prevalence of advanced CKM, at 18.9%, compared to 14.7% of Hispanic adults, 13.8% of white adults, and 11.4% of Asian adults
These findings underscore how important early detection and CKM treatment are, especially for high-risk populations.
Even individuals who appear otherwise healthy may already be in the early stages of CKM syndrome — making screening and intervention critical.
So, what does this mean for people living with diabetes?
For people with diabetes, these findings should serve as a wake-up call. Diabetes is already a major risk factor for both cardiovascular disease and kidney disease — two key components of CKM syndrome.
That means individuals with type 2 diabetes, in particular, are often already on the CKM spectrum, even if they don’t yet show CKM syndrome symptoms. In fact, many people may be classified as CKM stage 1 simply due to having diabetes or other metabolic conditions like obesity or hypertension.
The good news is that early diagnosis and intervention can make a meaningful difference. By addressing CKM syndrome proactively — through lifestyle changes, medications, and coordinated care across cardiology, nephrology, and endocrinology — patients with diabetes can prevent progression to more advanced stages.
For people managing type 2 diabetes, this is yet another reason to stay on top of lab work, attend regular checkups, and discuss CKM syndrome screening and CKM treatment with their healthcare team.
How is CKM Syndrome Diagnosed?
Getting an early diagnosis is crucial for the successful management of cardiovascular-kidney-metabolic syndrome.
Your doctor should run a combination of blood tests including a complete metabolic panel and urinalysis, an electrocardiogram and echocardiogram to assess heart function, and possibly imaging tests to evaluate kidney function.
Key tests for cardiovascular-kidney-metabolic syndrome include:
- Blood pressure test
- Lipid panel (total cholesterol, HDL, LDL, triglycerides)
- Metabolic panel that includes serum creatinine and GFR (glomerular filtration rate, which measures how well your kidneys are filtering your blood)
- Urine test for eGFR (estimated glomerular filtration rate) and UA/CR (urine creatinine ratio, which measures the amount of albumin and creatinine in your urine)
You may want to ask your doctor about getting a cardiac treadmill test (aka stress test), depending on your age and symptoms. You should also consider getting your own blood pressure cuff so you can measure your blood pressure at home at various times of day.
What Are the Treatments for Cardiovascular-Kidney-Metabolic Syndrome?
CKM treatment involves addressing the underlying conditions—heart disease, kidney disease, and metabolic issues—to prevent further damage and improve overall health. Treatment requires an integrated approach targeting all three areas:
Cardiovascular Support:
- Medications like beta-blockers, ACE inhibitors, ARBs, and mineralocorticoid receptor antagonists that help protect the kidneys and reduce heart strain
- Statins or other cholesterol-lowering drugs that reduce the risk of cardiovascular disease
- Device therapy (e.g., ICD or CRT in advanced heart failure)
Renal (Kidney) Protection:
- SGLT2 inhibitors
- Proper fluid management
- Adjusting medications to avoid damage to the kidneys
Metabolic Control:
- Blood sugar control using meds like GLP-1 RAs or SGLT2s that also provide protective benefits for the heart and kidneys
- Weight loss
The Role of Multidisciplinary Care in CKM Treatment
Because CKM syndrome involves overlapping issues across the heart, kidneys, and metabolic system, treatment is most effective when it’s coordinated across multiple specialties.
That means cardiologists, nephrologists, endocrinologists, and primary care providers must work together to develop a unified plan. When providers operate in silos, critical warning signs can be missed, and treatment strategies may conflict.
A multidisciplinary care model ensures that medications, lifestyle changes, and monitoring strategies are aligned to support all organ systems at once—not just one at the expense of another.
In this day and age, when access to physicians (especially specialists) can be difficult, multidisciplinary care isn’t always available or easy to coordinate so we have to be realistic. As a person with diabetes, you can do your part in making sure that your specialists have a way of easily communicating your health information to each other, especially if they work at different healthcare institutions.
Preventive Measures and Lifestyle Recommendations for CKM Treatment
The best way to address cardiovascular-kidney-metabolic syndrome is to start early in life with healthy habits. However, incorporating the following lifestyle modifications at any age can go a long way in supporting your overall health:
Nutrition:
A heart and kidney-friendly diet, such as the DASH or Mediterranean diet, focuses on whole grains, lean proteins, fruits, vegetables, and reduced salt and sugar.
Exercise:
Aerobic and strength-building exercises improve cardiovascular health, insulin sensitivity, and weight management.
Weight Management:
Losing excess weight can reduce strain on the heart, kidneys, and metabolic conditions.
Smoking Cessation:
Eliminating tobacco use helps improve blood vessel function and reduce disease progression.
Stress Management:
Practices like meditation and yoga can help control stress, which impacts blood pressure and glucose levels.
Key Takeaways
Cardiovascular-kidney-metabolic syndrome involves a complex interplay between diabetes and chronic kidney disease, cardiovascular disease, and metabolic issues. Managing the condition requires an integrated approach that addresses each condition.
If you’re experiencing symptoms like the ones mentioned above and you have risk factors such as diabetes, obesity, CKD, and cardiovascular disease, talk to your doctor.
A comprehensive treatment plan will ideally involve collaboration among healthcare providers—cardiologists, nephrologists, endocrinologists, and dietitians.
Early diagnosis, lifestyle modifications, and medications like SGLT2s and GLP-1s have shown promising results in lowering risks and improving outcomes. Learn more about the benefits of SGLT2s and GLP-1s and explore other type 2 diabetes management strategies in the TCOYD® video vault.
Additional Resources:
Keep Your Kidneys Kicking: Kidney Disease and Renal Health
A Dose of Dr. E: Protecting Your Kidneys
What Foods Should You Eat to Protect Your Kidneys
Show Some Love to Your Heart: Tips on Preventing Heart Disease
Reversing Type 2 Diabetes with a Plant-Based Diet
These 4 Minutes Can Save Your Life
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