Cardiovascular-kidney-metabolic (CKM) syndrome

What is CKM syndrome?

Cardiovascular-kidney-metabolic (CKM) syndrome is a health condition that affects your heart, kidneys and metabolism (how your body takes food and water and turns them into energy). CKM syndrome can develop over time as risk factors and health conditions begin to affect your heart, kidneys and metabolism. 

Conditions linked to CKM syndrome include:

• Kidney disease
• Cardiovascular (heart) disease
• Type 2 diabetes
• Overweight and obesity

Since these conditions are closely connected, having one can increase your risk of developing another. For example, having diabetes can damage the kidneys, and having kidney disease can increase the risk of heart problems. This important connection helps doctors look at these conditions together instead of treating them as separate health problems. Finding and treating CKM syndrome early may help prevent serious health issues.

What is the connection between kidney disease and CKM?

Your kidneys and heart work together to keep you healthy. Your kidneys help filter waste and extra fluid from your blood. When your kidneys are not working well, your heart may have to work harder. Kidney disease can also affect blood pressure, fluid balance, and blood vessel health, which can raise the chance of heart disease.

Conditions like diabetes, high blood pressure and obesity can also damage both your heart and kidneys. Because these conditions affect each other, managing your kidney health can also help protect your heart and overall health. Learn more

What are the symptoms of CKM syndrome?

Many people with CKM syndrome do not have symptoms in the early stages. As CKM syndrome gets worse, signs and symptoms may include:

• Feeling tired or weak (fatigue)
• Swelling in your feet, ankles or legs
• Leg pain while walking
• Shortness of breath
• Chest pain or pressure
• High blood pressure (hypertension)
• Needing to urinate (pee) more or less often
• Changes in appetite 
• Sleep apnea
• Gout
• Unexplained weight gain from fluid buildup in the body

What causes CKM syndrome?

CKM syndrome does not have one single cause. It develops over time when conditions that affect your heart, kidneys and metabolism are connected and affect one another.

Several health conditions can increase your risk of CKM syndrome, including:

• Overweight and obesity: long-term condition where a person has too much body fat
• Prediabetes: Having blood sugar levels that are higher than normal
• Type 2 diabetes: A condition in which blood sugar levels become too high over time because the body doesn't make enough insulin or doesn't use insulin well, leading to high blood sugar
• High blood pressure
• High cholesterol: Having unhealthy levels of fats or cholesterol in the blood
• Chronic kidney disease: Long term condition where the kidneys lose the ability to filter waste and fluid out of the blood
• Heart disease: broad category of diseases that affect the heart and blood vessels

Taking the right steps to care for your heart, kidneys and overall health may help prevent CKM syndrome or slow it from getting worse.

Who is at risk for CKM syndrome?

According to the American Heart Association, 1 in 3 adults in the United States have three or more risk factors for heart disease, diabetes or kidney disease. A risk factor is something that increases your chance of developing a health condition. Having one of the conditions means you're at higher risk of developing 1 or more of the other conditions.

You may be at higher risk for CKM syndrome if you have:

• Kidney disease
• Heart disease
• Prediabetes or type 2 diabetes
• High blood pressure
• High cholesterol 
• Overweight or obesity
• Metabolic dysfunction-associated steatotic (fatty) liver disease (MASLD), also known as Non-alcoholic Fatty liver disease 
• Sleep apnea (a condition that causes breathing problems during sleep)
• A family history of heart disease, kidney disease or diabetes

Some lifestyle factors can also increase your risk, including:

• Not getting enough physical activity
• Smoking or using tobacco products
• Eating patterns high in sodium (salt), added sugars and unhealthy fats
• Poor sleep habits

Talk to your doctor about your risk factors and steps you can take to protect your health

What are the stages of CKM and how do doctors treat each?

There are 5 stages of CKM: 

• Stage 0 CKM: No CKM risk factors 
• Stage 1 CKM: Early warning signs 
• Stage 2 CKM: Health risks start to show 
• Stage 3 CKM: Heart and blood vessel problems begin 
• Stage 4 CKM: Signs and symptoms of heart problems 

Learn more about each stage and how doctors treat it below.

Stage 0 CKM: No CKM risk factors 

At this stage, your focus is on preventing CKM. There is no need for treatment. To prevent future problems: 

• Eat plenty of fruits, vegetables, whole grains such as oats and brown rice, and lean proteins such as fish and beans. These can help lower your chance of CKM. 

• Be active for at least 30 minutes a day. Whether you walk or do yard work or yoga, be sure to move your body.  

• Be mindful of unhealthy habits. Maybe it is smoking, too much alcohol or too much TV – the first step is being aware of the habit. Then you can try to limit it or get help to stop the habit. Unhealthy habits can lead to CKM. 

Stage 1 CKM: Early warning signs 

At this stage, you may have: 

• Too much body fat, especially around the belly 

• Blood sugar levels that are higher than normal, but not high enough to have a diagnosis of type 2 diabetes,  this means you may have prediabetes  

How can I prevent moving to Stage 2 CKM? 

• Follow the prevention steps from Stage 0 

• Lose at least 5% of your body weight 

How do doctors treat Stage 1 CKM? 

• Treat and manage high blood sugar, if needed 

• Get your blood pressure, cholesterol, and blood sugar checked by a doctor every 2-3 years 

Stage 2 CKM: Health risks start to show 

At this stage, you may have: 

• Type 2 diabetes, high blood pressure or high levels of fat in your blood (high cholesterol) 

• Kidney disease 

How can I prevent moving to Stage 3 CKM? 

• Follow the prevention steps from Stage 0 

• Get your blood pressure, cholesterol and blood sugar checked by a doctor every year 

• Follow your doctor's instructions to prevent kidney disease from getting worse 

How do doctors treat Stage 2 CKM? 

• Take medicines to control diabetes and high blood sugar and lower cholesterol, if needed

Stage 3 CKM: Heart and blood vessel problems begin 

At this stage, you may have: 

• No clear signs or symptoms of heart problems yet, but your heart and blood vessels are starting to have issues 

How can I prevent moving to Stage 4 CKM? 

• Follow the prevention steps from Stage 0 

• Get your blood pressure, cholesterol and blood sugar checked by a doctor at least once a year. Talk with your doctor about how often to get checked, based on your health history.  

How do doctors treat Stage 3 CKM? 

• Change or raise the amount (dose) of medicine you take for diabetes, blood pressure or cholesterol 

• Get tested for artery problems (called a coronary artery calcium or CAC test) to decide on treatment options with your doctor

Stage 4 CKM: Signs and symptoms of heart problems  

People in Stage 4 feel and show signs of heart problems. They may have had a heart attack, stroke or heart failure. This stage has two substages:  

• Stage 4a: People without kidney failure  

• Stage 4b: People with kidney failure  

How do doctors treat Stage 4 CKM? 

• Personalized treatment for heart disease and other CKM syndrome conditions 

Take action: Talk with your doctor about CKM 

If you have heart disease, kidney disease, type 2 diabetes or obesity, talk with your doctor about specific ways to protect your health and prevent CKM.