Understanding Cardiovascular-Kidney-Metabolic (CKM) Syndrome

Cardiovascular-Kidney-Metabolic (CKM) syndrome is a newly defined condition that affects most major organs, including the kidneys, brain, heart, and liver. People with CKM syndrome experience a complex web of interconnected medical issues, including type 2 diabetes, obesity, chronic kidney disease (CKD), and cardiovascular disease.

CKM is increasingly prevalent within the US population. According to the American Heart Association, one in every three adults in the US has three or more risk factors associated with CKM syndrome.

As rates of obesity, type 2 diabetes, and hypertension (high blood pressure) contribute to worsened CKM health, researchers are warning of a public health emergency. So, what do you need to know about CKM health and the interplay between metabolic risk factors, chronic kidney disease (CKD), and cardiovascular health? What impact does CKM syndrome have on overall morbidity and mortality? And what can you do to manage and prevent the condition?

What is CKM Syndrome?

CKM syndrome refers to a combination of symptoms and medical conditions associated with cardiovascular health, kidney health, and metabolic health (which refers to things like blood pressure, blood sugar levels, and cholesterol levels).
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CKM can vary in severity, with some people only experiencing a few symptoms while others face numerous symptoms that have significant impacts on their daily lives. Left untreated, CKM syndrome can have consequences like heart failure, heart attack, stroke, arrhythmia (an irregular heartbeat), type 2 diabetes, CKD, and more.

So, what makes CKM syndrome unique? People with the syndrome experience a distinctly strong relationship between their cardiovascular health, kidney health, and metabolic health. Let’s take a closer look at those relationships. 

The Role of Chronic Kidney Disease in CKM Syndrome

Chronic kidney disease reduces your kidneys’ ability to filter waste products from your blood, regulate the production of red blood cells and blood pressure, and maintain a healthy balance of fluids and electrolytes in your body.
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CKD can also lead to cardiovascular risks, or risks affecting your heart, veins, and arteries. When the kidneys aren’t filtering waste from the body, it can lead to electrolyte imbalances, high levels of toxins in the blood, and high blood pressure. Those conditions, particularly high blood pressure, are major causes of heart attacks, heart failure, and stroke.

How Metabolic Risk Factors Influence CKD Risk

Obesity is associated with insulin resistance, high cholesterol, and hypertension — all of which can contribute to kidney failure over time. For example, insulin resistance can lead to hyperfiltration, which occurs when the kidneys filter too much blood, ultimately overworking and damaging glomeruli (the tiny blood vessels in your kidneys that work as filters).
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Likewise, if you have high blood pressure, your kidneys may not be receiving enough blood. This makes it harder for them to effectively filter your blood, which increases your blood pressure, which makes it harder for your kidneys to effectively filter your blood — a vicious, self-perpetuating cycle. 

Cardiovascular Disease and CKD: A Two-Way Street

Cardiovascular disease and chronic kidney disease have a complex and dynamic relationship. Both contribute to the other’s development, accelerating your health’s decline.

CKD can worsen cardiovascular disease by increasing your blood pressure and failing to regulate toxins from your blood. On the other hand, cardiovascular disease can contribute to CKD by reducing the amount of blood flowing to your kidneys and ultimately impacting their ability to function. 

CKM Syndrome’s Implications for Morbidity and Mortality

While research into CKM syndrome is relatively new, we know that morbidity and mortality rates across cardiovascular, metabolic, and kidney disorders are very high. Cardiovascular disease accounted for over 19 million deaths around the world in 2020.  Mortality among people with CKD in the US was over 100 per 1,000 in 2020, and approximately 66% of U.S. adults are overweight or obese.

Managing and Preventing CKM

Given the comorbidities involved with CKM health, tackling it requires a holistic approach that’s sustainable and supports long-term health. And while CKM represents a serious threat to public health, the good news is that it’s highly preventable and manageable. So, what can you do to minimize your risk for CKM and chronic diseases like kidney disease? Let’s take a look at some strategies.

Lifestyle Modifications

Maintaining a healthy weight through diet and physical activity is one of the best steps to prevent and manage CKM syndrome. Practical tips for embracing healthy habits include:

• Focus on eating plenty of fruits and vegetables, healthy fats, and lean proteins: One of the easiest ways to achieve this step is to avoid processed foods and embrace home cooking, ensuring you use a range of nutritious ingredients in your diet. Limiting your intake of sugary beverages and sweet treats can also significantly improve your metabolic health.
  
• Exercise regularly: Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous exercise each week. If you’re not in the practice of exercising, try gentle activities such as walking and swimming before beginning more intense exercises like running.
  
• Reduce your alcohol consumption. Alcohol can lead to hypertension and diabetes.
  
• Manage your stress: Stress management can improve cardiovascular health and prevent the need to overeat, which can lead to obesity, diabetes, and heart disease. Finding ways to manage your stress is critical for maintaining your overall health.
  

Medical Management

Nephrologists and cardiologists play an important role in managing CKM, helping to identify key conditions and comorbidities, as well as prescribing relevant medications.

Depending on your symptoms, you may benefit from blood pressure medications, antidiabetic medications such as metformin, statins and other lipid-lowering drugs, anemia drugs, and much more. If you have CKM, you may need to take a range of medications to optimize your long-term health.

Your care team, including cardiologists, primary care physician, and nephrologist will play a crucial role in ensuring your medications aren’t conflicting. Make sure that you communicate any changes in your medications to your care team.

Monitoring and Ongoing Care

Regular monitoring will help you stay on top of your symptoms and prevent or slow disease progression. Monitoring may include kidney function tests, blood tests, and other diagnostic tools to test your cardiovascular, kidney, and metabolic health.

The Bottom Line for CKM

CKM syndrome is an increasingly common condition characterized by connected declines in cardiovascular, kidney, and metabolic health. While CKM syndrome and the comorbidities it represents is complex, it is manageable.
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If you’re concerned about your kidney health, Milwaukee Nephrologists can help. With a team of board-certified specialists and a wide variety of sub-specializations, Milwaukee Nephrologists is Southeast Wisconsin’s go-to resource for kidney health concerns. Contact our team today to schedule an appointment, or visit our comprehensive resource library to learn more about protecting your kidney health!