New CKM syndrome guideline: What it means for kidney health

Did you know that heart disease, kidney disease, diabetes and obesity are all interconnected?

The American Heart Association defines cardiovascular-kidney-metabolic syndrome as a health condition that affects the heart, kidneys and metabolism. (Metabolism is how your body turns food and water into energy for the body to use.) Nearly 90% of U.S. adults have at least one component of CKM syndrome, according to the Heart Association. 

The Heart Association and the American College of Cardiology recently issued a guideline to help healthcare professionals identify CKM syndrome and take appropriate action to manage and protect long-term heart, metabolic and kidney health.  

Here are some key takeaways for people living with chronic kidney disease (CKD):

1. Understanding your CKM syndrome risk is important

The guideline recommends screening children, adolescents and adults. It also recommends risk prediction and classification into CKM syndrome stages, which helps determine severity and identify opportunities to:  

• Identify the best treatment options
• Prevent complications and stop CKM syndrome from progressing
• Protect kidney and heart health and reduce the likelihood of serious cardiovascular events (such as heart attack or stroke) and a loss of kidney function 
• Help people reduce their CKM syndrome stage through healthy lifestyle choices and weight loss 

People can shift between stages as their health conditions improve or worsen. 

2. Adults should be routinely assessed for CKM risk factors

Adults should be checked regularly for health issues that raise the risk of developing CKM syndrome, including:

• Reduced kidney function using estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR) 
• Prediabetes or Type 2 diabetes using blood glucose levels or A1c
• Obesity or being overweight by checking waist circumference and BMI
• Abnormal cholesterol and triglycerides by measuring a lipid panel
• Hypertension by measuring blood pressure
• Fatty liver disease using FIB-4 index
• Sleep apnea or sleep disorders through screenings for those conditions
• Autoimmune or inflammatory conditions through testing

3. Social determinants of health can affect risk for or progression of CKM syndrome

Screening social and lifestyle factors that affect general health can identify people at higher risk of developing or worsening CKM syndrome. Factors include: 

• Food insecurity (limited or uncertain access to quality, nutritious food)
• Housing instability (not having a safe, reliable place to live or being at risk of losing housing)
• Financial difficulties 

If one or more of these factors are identified, action should be taken to address the issue(s).

4. Care should be coordinated among healthcare specialists

People with more than one CKM-related condition (such as type 2 diabetes, CKD and heart disease) need an interdisciplinary approach to their care. This means they should have a team of healthcare professionals from different specialties working together to coordinate their care. These specialists can include:

• Nephrologists (kidney doctors) 
• Endocrinologists (diabetes & hormone specialists)
• Cardiologists (heart specialists)

Among this group of healthcare professionals, there should be a clear "point person" or main contact who is responsible for coordinating the patient's care. 

5. Obesity and excess abdominal fat should be addressed

People should be monitored for weight-related health issues using body mass index (BMI) and waist size measurements. These measurements help assess their risk of CKM syndrome. If a person has weight-related health issues, they should work with their clinicians to figure out the best treatments and lifestyle modifications to correct these issues, such as:

• Developing a healthy eating pattern
• Incorporating physical activity/exercise 
• Medicines that may decrease appetite or help with weight loss
• Bariatric (weight loss) surgery when appropriate

6. Diabetes medicines can help protect the heart and kidneys

Medicines that help manage diabetes and high blood sugar can also help protect the heart and kidneys. These medicines include:

• Sodium-glucose cotransporter-2 inhibitors (SGLT2i), which lower blood sugar by allowing the kidneys to remove excess glucose (sugar) from the blood and get rid of it through urine (pee)
• Glucagon-like peptide-1 (GLP-1) based therapies, which help the body use insulin better to lower blood sugar levels and can be effective in managing type 2 diabetes and obesity

Medicines and therapies should match the person's health conditions. These may include CKD, heart and vascular disease, heart failure, obesity, high blood sugar, liver disease and others. 

7. Kidney function should be regularly monitored — medicines that protect the heart and kidneys are important

People with CKD should have regular monitoring of their kidney health with eGFR and uACR tests to classify CKD risk and determine what medicines should be used to help protect the kidneys and the heart.

People with CKD and diabetes or CKD and albuminuria (protein in the urine) should be given SGLT2 inhibitors and renin-angiotensin system inhibitors (RASi) first. If albuminuria remains an issue for people with CKD and type 2 diabetes, GLP-1 based therapies or non-steroidal mineralocorticoid receptor antagonists (nsMRA) should be used for added heart and kidney protection. 

8. CKM risk factors should be addressed at every visit

The CKM syndrome treatment plan should be revisited at every appointment. It's important to talk through updates, understand medicines and dosages.

Learn more about CKM syndrome, the link between heart disease and kidney disease, the link between obesity and kidney disease and the connection between diabetes and kidney health. You can also learn more about the American Heart Association's CKM Health Initiative here.