An overview of cardiovascular-kidney-metabolic syndrome

Cardio-kidney-metabolic (CKM) syndrome is a term to describe the interconnection between cardiovascular disease, type 2 diabetes, and chronic kidney disease. The National Health and Nutrition Examination Survey from 1999 to 2020 estimated that 25% of participants had at least 1 CKM condition. It is proposed that CKM syndrome originates in excess and/or dysfunctional adipose tissue, which secretes proinflammatory and prooxidative products leading to damaged tissues in arteries, the heart, and the kidney, and reduction in insulin sensitivity. CKM syndrome is classified into 4 stages based on the presence of risk factors and clinical signs. Risk factors associated with progression of CKM syndrome include chronic inflammatory conditions, family history of diabetes or kidney disease, mental health and sleep disorders, increased levels of elevated high-sensitivity C-reactive protein, and sex-specific risk enhancers. There are substantial racial and ethnic differences, although they are likely due to social determinants of health (SDOH). The American Heart Association suggests that CKM syndrome screening should include both biological factors and SDOH. Interventions in patients with stages 0 to 3 CKM syndrome focus on preventing future cardiovascular events by management of excess adiposity, mainly through diet and exercise in the early stages, then through pharmacological treatment of metabolic syndrome components in later stages. There is a general acceptance that treatment of CKM syndrome should involve a holistic approach to prevention, screening, and management to improve outcomes and reduce long-term morbidity and mortality.