Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A New Term for An Old Approach

The human body is a complex of organ systems that strives to achieve homeostasis, which is the tendency to maintain internal stability by coordinating the response of its various parts to any situation or stimulus that may disturb its normal functioning.

These organ systems are intimately related and can’t be thoroughly evaluated without considering the effect of one system upon the other, an approach used in naturopathic and functional medicine but not commonly used in allopathic medicine.

Traditionally, allopathic medicine separates the physiological systems of the body into unrelated categories, i.e., cardiology, gastroenterology, endocrinology, psychiatry, etc. However, over time, there has been a tendency for allopathic medicine to follow in the footsteps of naturopathy and evaluate human physiology as a whole, with systems that affect and depend upon each other.

Recently, the American Heart Association coined the term “Cardiovascular-Kidney-Metabolic (CKM) Syndrome,” recognizing the relationship between type 2 diabetes, obesity, chronic kidney disease, and cardiovascular disease. This acknowledgment also recognizes the potential adverse effects of CKM on every organ in the body, including the brain and liver.

An estimated one out of every three adults has at least three risk factors contributing to metabolic dysfunction, CVD, and/or kidney disease. Screening for these risk factors can ultimately reduce the risk of these common chronic disorders,

The 4 stages of CKM:

Stage 0 CKM     

• No risk factors
• Healthy eating and sleep habits
• Physical activity
• Optimal weight and blood pressure
• Optimal cholesterol levels
• Avoidance of nicotine
• Screen every 3-5 years

Stage 1 CKM

• Excess body fat or abdominal obesity
• Impaired glucose tolerance or “prediabetes”
• Screen every 2-3 years

Stage 2 CKM

• Type 2 diabetes
• Hypertension
• Hypertriglyceridemia
• Kidney disease
• Screen annually or more frequently if kidney function worsens

Stage 3 CKM

• Early, asymptomatic CVD in those with metabolic risk factors or kidney disease
• Those at a high risk of CVD
• Lifestyle changes and weight loss may revert stage 3 to a less severe stage
• Screen annually or more frequently as needed

Stage 4 CKM

• Symptomatic CVD in those with metabolic risk factors, excess body fat, or kidney disease (with or without kidney failure)
• May have already experienced a myocardial infarction, stroke, or heart failure
• May have peripheral artery disease or atrial fibrillation
• Monitor closely

Ongoing risk assessment should include:

• Age
• Gender
• Race
• Social and community factors
• Blood pressure
• Nutrition status
  • Diet quality
  • BMI
  • Waist circumference
  • Body composition
• Blood chemistry data
  • Blood glucose
  • Hemoglobin A1C
  • Cholesterol
  • Triglycerides
  • Albumin, albuminuria
  • eGFR

References

AHA. Heart disease risk, prevention and management redefined. https://newsroom.heart.org/news/heart-disease-risk-prevention-and-management-redefined October 9, 2023.

Ndumele, Chiadi E et al. “A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association.” Circulation, 

ODX Optimal Takeaways

Consider the profound connection between lifestyle, environment, social interactions, psychology, and health, and evaluate each person individually.

Encourage early screening for CKM, especially for high-risk individuals.

Advanced ODX screening may include:

Blood glucose regulation

Kidney function

Cardiovascular risk

Inflammation

Oxidative Stress Factors

Note: It would also be prudent to assess liver status, thyroid function, hormone balance, micronutrient status, adrenal function, and stress factors.