- American Heart Association
officials say kidney disease is part of a constellation of chronic health
conditions that include cardiovascular disease, type 2 diabetes, and
obesity.
- They have presented a newly
defined cardiovascular-kidney-metabolic (CKM) syndrome that adds kidney disease to the connection.
- Experts say the CKM definition
can improve prevention, intervention, and treatment through more
integrated care.
Cardiovascular disease, type 2
diabetes, and obesity have long been linked through
research and in disease prevention and treatment protocols.
The American Heart Association says that another chronic
health problem, kidney disease, should also be included.
In a presidential advisory Trusted Source issued in the
journal Circulation, the association for the first time defined
cardiovascular-kidney-metabolic (CKM) syndrome and called on the healthcare
community to integrate care for the related diseases.
“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 press statement Trusted Source. “Screening for kidney and
metabolic disease will help us start protective therapies earlier to most
effectively.”
“Cardiovascular disease, obesity, diabetes, and kidney
disease have shared risk factors and can each contribute to the development and
progression of each other,” Dr. Dmitry
Abramov, a cardiologist at Loma Linda University International Heart
Institute in California, told Medical News Today. “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.”
What to know about new cardiovascular-kidney condition
According to the American Heart Association’s 2023 Statistical UpdateTrusted Source, one in three U.S.
adults have three or more risk factors that contribute to cardiovascular
disease, metabolic disorders, and/or kidney disease.
“CKM affects nearly every major organ in the body, including
the heart, brain, kidney and liver,” according to the association. ”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/or
an unhealthy distribution of body fat, such as abdominal obesity, and/or
impaired glucose tolerance or pre-diabetes.
- Stage 2: Metabolic risk factors
(includes people with type 2 diabetes, high blood pressure, high
triglycerides) and kidney disease.
- Stage 3: Early cardiovascular
disease without symptoms in people with metabolic risk factors or kidney
disease or those at high predicted risk for cardiovascular disease.
- Stage 4: Symptomatic
cardiovascular disease in people with excess body fat, metabolic risk
factors or kidney disease.
“This classification helps both physicians and patients
understand their risks for developing cardiac risk factors like obesity,
diabetes, hypertension and heart failure,” Dr. Majid Basit, a cardiologist with Memorial Hermann Health System
in Houston, told Medical News Today. “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,” Basit added. “Defining a
patient’s stage helps the physician and the patient identify disease risk and
the therapies indicated for that particular stage.”
“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,” Ndumele
said.
Prevention, intervention, and treatment for CKM syndrome
A fragmented treatment system, however, means that doctors
may not be aware of these therapies or treat CKM holistically.
“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,” said Abramov.
“The advisory suggests ways that professionals from
different specialties can better work together as part of one unified team to
treat the whole patient,” 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.”
“Physicians, including primary care doctors, diabetes
specialists, kidney specialists, and cardiologists are all involved in the care
of CKM patients,” said Basil, who noted that intervention can start in
childhood. “Pediatricians can help identify patients at risk at an early age,”
he said. “The obesity pandemic along with a sedentary lifestyle has led to patients
with CKM syndrome well before adulthood.”
“Multidisciplinary care is key because patients with
obesity, diabetes, and kidney disease often see a large number of clinicians,”
added Abramov. “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 American Heart Association 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), and social determinants of health.
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