- CRHM syndrome is a newly recognized condition that links the health of your heart, kidneys, and liver. Problems in one organ can impact the others, while improving the health of one can help protect them all.
- The primary cause of CRHM is metabolic syndrome, which is very common in type 2 diabetes.
- Heart, kidney, and liver disease can develop silently for years, so regular screening is crucial to catch problems before symptoms appear.
- Medications like GLP-1s, SGLT inhibitors, and nsMRAs can help protect multiple organs, and you can even take all three medications at the same time as they all work in different ways.
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We’ve known for a while that the heart and kidneys have a very close relationship…in sickness and in health, til death do they part!
In other words…what affects one often impacts the other.
Then researchers discovered that metabolic syndrome plays a major role in the health of these two organs too, so the trio became known as cardiovascular-kidney-metabolic syndrome (CKM).
Recently, experts realized that the liver is part of the mix too. So what we used to think of as three separate issues (heart disease, kidney disease, and liver disease) has morphed into one, prompting the mysterious people who name medical conditions to coin a new one: cardio-renal-hepatic-metabolic syndrome, or CRHM syndrome (trust us, it rolls off the tongue if your tongue went to Harvard).
So what does all this bodily organ history mean for you?
Two things:
- If you have a problem with one of these systems, the others are likely affected too.
- If you take steps to improve your health in one area, it can have positive ripple effects on the others.
What Exactly Is CRHM Syndrome?
CRHM syndrome is a condition that affects three major organs in your body – your heart (cardio), your kidneys (renal), and your liver (hepatic). The underlying cause of CRHM is metabolic syndrome (we’ll get into that next).
These systems are constantly communicating and relying on each other, so when one isn’t working as well as it should, the others are often affected.
For example:
- Heart problems can reduce blood flow to the kidneys.
- Kidney disease can increase the workload on the heart.
- Liver disease is closely linked with insulin resistance and inflammation, which can also increase the risk of heart and kidney disease.
Insulin resistance and inflammation are the underlying pathophysiologic defects of the heart, kidneys, and liver.
What Causes CRHM?
The primary cause of CRHM is metabolic syndrome, which is a cluster of conditions that sets the stage for heart disease, kidney disease, liver disease, and type 2 diabetes.
Metabolic syndrome occurs when you have at least three of the following conditions:
- Obesity
- Insulin resistance
- Chronic inflammation
- Elevated blood sugar
- High blood pressure
- Abnormal cholesterol (high triglycerides and low HDL “good” cholesterol)
- Endothelial dysfunction (when the lining of your blood vessels becomes damaged, making it harder for blood to flow)
Ultimately, all of these issues put extra stress on your blood vessels and interfere with how your heart, kidneys, and liver function.
Why Are People with Diabetes at Risk for CRHM Syndrome?
Insulin resistance is the main driver of type 2 diabetes, and most people with type 2 diabetes also have:
- Obesity
- High blood pressure
- Chronic inflammation
- Abnormal cholesterol
All of these factors contribute to metabolic syndrome, which is the foundation of CRHM.
Although CRHM syndrome is more common in people with type 2 diabetes, people with type 1 diabetes can develop it too, especially if they have metabolic risk factors.
CRHM Symptoms, Screening, and Diagnosis
One of the challenging aspects of CRHM syndrome is that abnormalities in your heart, kidneys, and liver can develop quietly over time, often without any symptoms in the early stages.
Also, there isn’t one specific test to check for CRHM. This means we have to look at each organ individually, so your doctor should be checking your cholesterol, blood pressure, kidney function, and liver function at least once a year to help catch potential problems early.
There are several tests your healthcare provider can run, but here are some of the important ones:
Heart Health Tests:
Cardiac markers like NT-proBNP can help identify signs of stress on the heart.
Kidney Function Tests:
Tests like eGFR (estimated glomerular filtration rate) and urine albumin-creatinine ratio (uACR) can help evaluate how well your kidneys are working and check for early signs of kidney damage.
Liver Health Tests:
The FIB-4 Index is a calculation that uses four numbers (results from your AST and ALT liver enzyme tests, your platelet count, and your age) to estimate your risk of liver scarring (fibrosis).
What If Your Test Results Aren’t Normal?
If your test results come back with elevated values, the first step is to have a conversation with your healthcare provider about what your numbers mean and what you can do next.
Depending on your situation and which area needs attention, you may be referred to a cardiologist (heart specialist), nephrologist (kidney specialist), or liver specialist for further evaluation and treatment options.
In the meantime, you can continue working on the things we know help protect your metabolic health:
- Managing blood pressure
- Keeping cholesterol levels in a healthy range
- Staying active
- Avoiding tobacco
- Working toward a healthy body weight (we know it’s easier said than done)
How to Treat CRHM Syndrome
Even though CRHM syndrome affects multiple organs that need to be monitored individually, you don’t necessarily need a separate medication to treat each one.
Many of today’s medications like GLP-1s, SGLT inhibitors, and nsMRAs were originally developed for specific conditions related to type 2 diabetes, but research has shown they can provide benefits in multiple areas, including the heart, kidneys, and liver.
GLP-1 Receptor Agonists:
GLP-1s help lower blood sugar and support weight loss, but many have also been shown to improve insulin resistance, reduce the risk of heart attack and stroke, protect kidney function, reduce liver fat, and improve MASLD/MASH. Examples of GLP-1s are Ozempic & Wegovy (semaglutide), Mounjaro & Zepbound (tirzepatide, a GLP-1/GIP), Trulicity, and Victoza.
SGLT Inhibitors
SGLT inhibitors were developed to lower blood sugar in people with type 2 diabetes, but they’re now a cornerstone treatment for chronic kidney disease and heart failure. They may also reduce liver fat, although none are currently FDA-approved for liver disease. Examples of SGLTs are Jardiance, Farxiga, Invokana, and Inpefa.
Non-Steroidal MRAs
Non-steroidal mineralocorticoid receptor antagonists (nsMRAs) are one of the newest medication classes used to protect the kidneys and heart. The only FDA-cleared medication in this class is Kerendia (finerenone), which is indicated for people with chronic kidney disease associated with type 2 diabetes, and for people with heart failure with mildly reduced or preserved ejection fraction.
Studies have shown that finerenone can also lower the risk of certain cardiovascular events, as well as reduce inflammation and fibrosis in the liver.
Other Ways to Protect Your Heart, Kidneys, Liver, & Metabolic Health
While these newer medications can cover a lot of ground, the tried-and-true foundations of diabetes care are still important:
- Glucose Management: Keeping blood sugars in your target range as much as possible helps protect blood vessels and reduces the risk of complications.
- Blood Pressure Management: Healthy blood pressure is one of the most important ways to protect your heart and kidneys.
- RAS Inhibitors (including ACE Inhibitors and ARBs): These medications have been used for decades to help protect the kidneys and cardiovascular system.
- Weight Management: Do the best you can to maintain a healthy weight (we know it’s hard!).
- Healthy Lifestyle Habits: Regular physical activity, balanced nutrition, quality sleep, and avoiding smoking can all help support your metabolic health.
CRHM Syndrome: Frequently Asked Questions
🚫 Is CRHM syndrome preventable?
The short answer is yes. While genetics can play a role (you can thank your parents!), CRHM syndrome is primarily driven by metabolic factors that can often be prevented or reversed if they’re caught early (shout-out to the screening section above). A lot of headway can be made with lifestyle changes like nutrition, exercise, and weight management, and medications are very effective at providing multi-organ protection.
☝️ Does it matter which medication you take first?
You want to treat the issue that’s the biggest concern first. For example, if heart failure is your primary concern, an SGLT inhibitor may be prioritized because of its strong heart failure benefits.
If excess weight and insulin resistance are bigger challenges, a GLP-1 may be the way to go.
If kidney disease is progressing, medications like SGLT inhibitors and/or Kerendia may be recommended.
💊 Can you take more than one medication for CRHM Syndrome?
Absolutely! If you have type 2 diabetes, overweight or obesity, heart disease, and/or declining kidney function, your doctor may recommend a combination of these medications. Many people benefit from taking all three medication classes together because they work in different ways and provide complementary benefits. The best treatment plan is one you’ll develop with your healthcare provider based on your medical history and individual needs.
❤️🩹 What organ is damaged when you have diabetes?
That’s a great question! If you were to take a poll on the street, most people might say that diabetes affects your nerves and your eyes. But very importantly, diabetes affects your heart, your kidneys, and your liver. That’s why screening early for CRHM syndrome is so important.
CRHM Syndrome Takeaways: A Diagnosis with Good News
No one would argue that cardio-renal-hepatic-metabolic syndrome is a medical mouthful and a lot to absorb, but the concept is simple: your heart, kidneys, liver, and metabolism are all connected, and what affects one often affects the others.
The good news here is that the connection works both ways. Meaning, when you improve one area, it can have a domino effect in the others.
Now that CRHM is becoming more widely known, healthcare providers are screening for these conditions earlier. And research on GLP-1s, SGLTs, and MRAs is continually advancing, with ongoing studies exploring how these medications can provide even greater protection for the heart, kidneys, liver, and overall metabolic health.
CRHM may sound like the name of a law firm, but the goal is simple. Keep all four partners – your heart, kidneys, liver, and metabolic health – out of trouble…NOT THAT WE WANT TO KEEP LAWYERS HEALTHY! 😉
This article was supported by an unrestricted educational grant from Bayer.
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