CKM Syndrome Linked to Heart, Kidney, and Metabolic Diseases

The American Heart Association (AHA) has issued a presidential advisory on cardiovascular-kidney-metabolic (CKM) syndrome, which is a health disorder that refers to the interrelated conditions of chronic kidney disease (CKD), cardiovascular disease (CVD), and metabolic disorders, such as diabetes mellitus. These conditions often coexist and can exacerbate each other, leading to a complex clinical scenario that requires a multifaceted approach to management. CKD can lead to disturbances in mineral and bone metabolism, which are associated with cardiovascular pathology, such as vascular calcification and left ventricular hypertrophy. These cardiovascular changes, in turn, increase the risk of cardiac events in patients with CKD. Additionally, metabolic conditions, like diabetes and obesity, contribute to the development of both CKD and CVD, creating a cycle of worsening health.

The advisory describes the urgency of CKM syndrome, suggests consensus on defining and staging the condition, offers suggestions for screening, and provides approaches and algorithms for each stage. It also emphasizes the importance of addressing social determinants of health, the interdisciplinary team approach needed to effectively treat CKM syndrome, and identifies knowledge gaps.

The diagnosis of CKM involves screening for kidney and metabolic diseases to identify individuals at early stages of the syndrome. The syndrome can be broken down into stages, each of which correlates to specific screenings and therapies to detect CKM-related health changes and prevent progression to the next stage.

• Stage zero: No risk factors for CKM and individuals with normal weight, BMI, and lipid profile.
• Stage one: Individuals with excessive abdominal obesity or those who have prediabetes.
• Stage two: Individuals with metabolic risk factors, high blood pressure, high triglycerides, or Type 2 diabetes.
• Stage three: Individuals with early cardiovascular or kidney disease who don’t have symptoms yet.
• Stage four: Individuals with diagnosed cardiovascular or kidney disease. They may have already experienced a heart attack, stroke, or heart failure.

The treatment options for CKM include a multifaceted approach that addresses the interconnected nature of the condition. The AHA's presidential advisory suggests various treatment approaches, including the early use of medications, such as sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. These medications have been shown to have cardioprotective effects and can favorably affect metabolic risk factors and kidney function. Additionally, the advisory emphasizes the importance of personalized treatment for heart disease and other CKM syndrome conditions, as well as the need for a holistic and interdisciplinary approach to care that includes the following:

• Interdisciplinary Team Approach: Involving physicians, scientists, nurses, and other healthcare providers to provide comprehensive care for patients with CKM syndrome.
• Personalized Treatment Strategies: Tailoring treatment plans to the individual patient, taking into account their specific cardiovascular, kidney, and metabolic conditions.
• Early Intervention: Implementing early use of medications, such as sodium-glucose transport protein 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, which have been shown to have cardioprotective effects and can favorably affect metabolic risk factors and kidney function.
• Social Determinants of Health: Addressing social determinants of health, which are often critical drivers of CKM syndrome, and integrating social determinants of health assessments and interventions into care.
• Care Coordination and Integration: Reducing care fragmentation by facilitating patient-centered interdisciplinary care and integrating care models for CKM syndrome.
• Prevention Across the Life Course: Promoting prevention across the life course and incorporating considerations of social determinants of health into care models for CKM syndrome.

CKM is a complex and multifaceted syndrome that heightens the risk of cardiovascular and kidney diseases. The AHA's advisory on cardiovascular kidney metabolic syndrome provides clinicians with a practical framework to identify, evaluate, and manage CKM components. By addressing CKM, we can reduce the burden of cardiovascular and kidney diseases, which are two leading causes of mortality and morbidity in our society.

References

Cardiovascular-kidney-metabolic health: A presidential advisory from ... Accessed December 12, 2023. https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001184.

Cardiovascular Kidney Metabolic Health: A presidential advisory from the AHA. professional.heart.org. Accessed December 12, 2023. https://professional.heart.org/en/science-news/cardiovascular-kidney-metabolic-health-a-presidential-advisory.

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