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Cardiovascular-kidney-metabolic (CKM) syndrome

Learn about cardiovascular-kidney-metabolic (CKM) syndrome, its risk factors and the connection between heart disease, kidney disease, type 2 diabetes and obesity.

What is CKM syndrome?

Cardiovascular-kidney-metabolic (CKM) syndrome is a health condition that affects your heart, kidneys and metabolism (your body's process for getting energy from food). It happens when these three parts of your body do not work as well as they should.  

CKM is a new health condition defined by experts studying the connection between heart disease, kidney disease, type 2 diabetes and obesity.

What is the connection between kidney disease and CKM?

Experts have found that people with heart disease (which is also called cardiovascular disease or CVD) have a higher chance of getting other health conditions, such as kidney disease, type 2 diabetes and obesity. Likewise, people with kidney disease, type 2 diabetes or obesity also have a higher chance of getting heart disease.  

CKM syndrome highlights the strong connection and shared risk factors for all these conditions. Risk factors are things that give you a higher chance of having a health condition. 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.

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.