- American Heart Association officials say kidney disease is part of a constellation of chronic health conditions, including cardiovascular disease, type 2 diabetes, and obesity.
- They presented CKM syndrome, a newly defined cardiovascular-kidney-metabolic disorder that adds kidney disease to the connection.
- Experts say defining CKM as a disorder could help improve prevention, intervention, and treatment through more integrated care.
Cardiovascular disease, type 2 diabetes, and obesity have long been linked through research, disease prevention, and treatment protocols.
The American Heart Association (AHA) has identified another chronic health problem and says that kidney disease should also be included.
For the first time, the AHA defined cardiovascular-kidney-metabolic (CKM) syndrome and called on the healthcare community to integrate care for the related diseases. The statement was issued in a presidential advisory published in the journal
“The advisory addresses the connections among these conditions with a particular focus on identifying people at early stages of CKM syndrome,” said Dr. Chiadi Ndumele, the writing committee chair and an associate professor of medicine and director of obesity and cardiometabolic research in the division of cardiology at Johns Hopkins University in Baltimore, in a
“Screening for kidney and metabolic disease will help us start protective therapies earlier to most effectively.”
According to the AHA’s
- cardiovascular disease
- metabolic disorders
- kidney disease
“CKM affects nearly every major organ in the body, including the heart, brain, kidney and liver,” according to the AHA.
”However, the biggest impact is on the cardiovascular system, affecting blood vessels and heart muscle function, the rate of fatty buildup in arteries, electrical impulses in the heart and more.”
The advisory outlined four stages of CKM along with prevention and treatment protocols:
- Stage 1: Excess body fat and unhealthy body fat distribution, such as abdominal obesity and impaired glucose tolerance or prediabetes.
- Stage 2: Metabolic risk factors, including people with type 2 diabetes, high blood pressure, and high triglycerides, and kidney disease.
- Stage 3: Early cardiovascular disease (CVD) without symptoms in people with metabolic risk factors, kidney disease, or those at high predicted risk for heart disease.
- Stage 4: Symptomatic cardiovascular disease in people with excess body fat, metabolic risk factors, or kidney disease.
“The advisory provides guidance for healthcare professionals about how and when to use those therapies, and for the medical community and general public about the best ways to prevent and manage CKM syndrome,” Dr. Ndumele stated.
Dr. Majid Basit, a cardiologist with Memorial Hermann Health System in Houston, not involved in the study told Medical News Today:
“This classification helps both physicians and patients understand their risks for developing cardiac risk factors like obesity, diabetes, hypertension and heart failure. These diseases are all linked together, and having one increases your risk of developing the others. Although the classification of CKM syndrome is new, the underlying concept is well understood by physicians. Defining a patient’s stage helps the physician and the patient identify disease risk and the therapies indicated for that particular stage.”
A fragmented treatment system means doctors may not know the therapies for CKM or understand how to treat the disorder holistically.
“The advisory suggests ways that professionals from different specialties can better work together as part of one unified team to treat the whole patient,” Dr. Ndumele said.
“There is a need for fundamental changes in how we educate healthcare professionals and the public, how we organize care and how we reimburse care related to CKM syndrome. Key partnerships among stakeholders are needed to improve access to therapies, to support new care models, and to make it easier for people from diverse communities and circumstances to live healthier lifestyles and to achieve ideal cardiovascular health,” Dr. Ndumele continued.
Dr. Dmitry Abramov, a cardiologist at Loma Linda University International Heart Institute in California, told MNT:
“Cardiovascular disease, obesity, diabetes, and kidney disease have shared risk factors and can each contribute to the development and progression of each other. Targeting kidney disease adds an extra pathway to reduce not only the progression of kidney disease itself, often saving patients from the difficulties of dialysis, but also to reduce progression of cardiovascular disease and other associated conditions.
Clinicians and patients have an increasingly large number of tools to improve their cardiovascular health, and this advisory is a key step in increasing physician and public awareness of the multiple treatments that are available but underutilized today.”
Dr. Basit noted that healthcare professionals such as physicians, primary care doctors, diabetes specialists, kidney specialists, and cardiologists can all be involved in the care of CKM patients. He pointed out that intervention could start during childhood.
“Pediatricians can help identify patients at risk at an early age,” Dr. Basit said. “The obesity pandemic along with a sedentary lifestyle has led to patients with CKM syndrome well before adulthood.”
Dr. Abramov added that multidisciplinary care is crucial.
“Patients with obesity, diabetes, and kidney disease often see a large number of clinicians,” Dr. Abramov said. “Collaboration between the treatment team on a shared message and treatment plan will add expertise to optimize medical care and will help empower patients to better understand the multiple treatment options available.”
The AHA also called for updating the standard assessment tool known for atherosclerosis cardiovascular risk, known as the Pooled Cohort Equation.
They recommended the update include:
- measures of kidney function
- type 2 diabetes control (using blood test results instead of a yes/no response)
- social determinants of health