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What Is CKM Syndrome? Causes, Treatments, and Prevention

6 Minute Read
CKM syndrome describes the condition of overlapping diabetes, obesity, heart disease, and kidney disease

Key takeaways: 

  • Cardiovascular-kidney-metabolic (CKM) syndrome (CKM) describes the complex health disorder caused by connections between diabetes, obesity, heart disease, and kidney disease. 
  • Preventing CKM syndrome involves maintaining a healthy body weight, eating healthy foods and being physically active.
  • Taking medications to manage blood sugar, blood pressure, and cholesterol may be necessary. 
  • By creating this new term, scientists and physicians hope to call attention to these overlapping conditions and spur more research into the full spectrum of CKM. 

It’s not uncommon for people with diabetes to develop other complications such as obesity, kidney disease, or heart disease. In addition, other conditions like metabolic dysfunction-associated steatohepatitis (MASH), a type of liver disease, are also increasingly linked with diabetes.

What is CKM syndrome?

In late 2023, the American Heart Association (AHA) created the term cardiovascular-kidney-metabolic (CKM) syndrome. CKM syndrome describes the health disorder that is caused by connections among diabetes, obesity, heart disease, and kidney disease. There are different stages of CKM syndrome, depending on how many risk factors and health conditions you have. 

People with type 2 diabetes often have more than one of these health conditions, and each condition can cause or worsen the others. For instance, adults living with diabetes are twice as likely to have heart disease compared with those who don’t have diabetes, and about one-third of people with diabetes develop chronic kidney disease, notes the National Kidney Foundation.

Why is the term CKM syndrome important? 

According to the AHA, one in three adults living in the U.S. have three or more risk factors for cardiovascular-kidney-metabolic syndrome. 

Cardiovascular-kidney-metabolic syndrome can ultimately cause dysfunction of multiple major organs like the heart, kidneys, liver, and brain. This leads to a high rate of complications, such as heart disease, heart attacks and strokes. 

By creating a term to describe these interconnected diseases, researchers hope to better understand and manage these conditions. Collaboration across different healthcare specialists – endocrinologists, cardiologists, and nephrologists – is key. For instance, as stated above, incorporating healthcare providers from different disciplines of medicine can allow for a better understanding of the risks and benefits of medications on different organ systems. 

Collaboration will also allow for more research into all the conditions identified as part of  CKM syndrome. For instance, people with chronic kidney disease (CKD) have often been left out of clinical trials in the past due to concerns about safety. 

What causes CKM syndrome? 

According to research by the AHA, cardiovascular-kidney-metabolic syndrome is most commonly caused by either too much adipose (fat) tissue or adipose tissue in the wrong places like the heart, liver and abdomen. Dysfunctional adipose tissue can release substances that cause inflammation or damage to the arteries, heart, and kidneys. Inflammation also reduces insulin sensitivity, leading to poor glucose tolerance and diabetes. 

What are risk factors for CKM syndrome?

Factors that affect the risk of CKM include: 

What are symptoms of CKM syndrome? 

CKM syndrome may not have any symptoms. If it does, the symptoms are related to the connected conditions like diabetes, kidney disease and heart disease. For instance, symptoms may include: 

  • Shortness of breath
  • Chest pain 
  • Passing out
  • Swelling in your hands, feet, legs, or ankles
  • Pain in your legs when walking
  • Fatigue
  • Changes in appetite
  • Feeling like you need to pee more often
  • Dry skin
  • Sleep apnea
  • Gout

Your height and weight, blood pressure as well as blood and urine tests for A1C, cholesterol, triglycerides, kidney health (including urine albumin creatinine ratio) and other routine laboratory tests can help you learn if you have any component of CKM syndrome.

How is CKM syndrome treated? 

Managing CKM syndrome involves managing all of the individual components of this condition. This includes losing weight and improving blood sugar, blood pressure, triglycerides, and cholesterol.

The first recommendation is lifestyle changes. For instance, this includes eating a nutritious diet with plenty of whole grains, reducing intake of saturated fats. It’s also important to get regular physical activity, if you’re not already, or increase physical activity if you’re already trying to be active. 

Of course, managing diabetes is also a key part of treating CKM syndrome. For people with type 2 diabetes, this may involve weight loss through dietary change and physical activity. 

Beyond body weight, good glucose control is important. Simple things like getting a good night’s sleep and staying hydrated can help improve your time in range – ideally, your time in range should be above 70%. Of course, using diabetes technology like continuous glucose monitors (CGM) can also help you better understand your glucose patterns and reduce unwanted highs and lows. Some people with diabetes may need automated insulin delivery (AID) systems to control their blood glucose.

Taking medications such as statins may be necessary to help lower cholesterol and reduce the risk of cardiovascular disease.

Treatment may also involve other medications that protect the heart and other organ systems, such as SGLT-2 inhibitors and GLP-1 receptor agonists. In general, SGLT-2s are preferred for people with kidney disease and heart failure, and GLP-1s are preferred for those with obesity, severe hyperglycemia, and high risk of atherosclerotic cardiovascular disease. 

Excitingly, evidence from a recent clinical trial suggests that GLP-1s also slow progression of kidney disease. In the FLOW study, people with type 2 diabetes and CKD who took Ozempic (semaglutide) had a 24% reduction in progression of kidney disease. Going forward, it’s possible that these medications may be used together with SGLT-2s for people with chronic kidney disease.

CKM syndrome: The bottom line

It’s common for people with diabetes to develop complications over time, and many complications share common causes. The combination of diabetes, obesity, heart disease, and kidney disease are now grouped together in what is known as cardiovascular-kidney-metabolic syndrome. With greater awareness of these overlapping conditions, healthcare providers and researchers will be able to better understand and treat them. 

To prevent or manage cardiovascular-kidney-metabolic syndrome, it’s important to stay on top of diabetes management. This means working toward good glycemic control, eating a nutritious diet, and getting regular physical activity. Managing blood pressure, cholesterol, and triglycerides is also key. Diabetes medications like SGLT-2s and GLP-1s may offer valuable protection against kidney disease and heart disease in addition to their glucose-lowering effects. 

As a starting step, attending annual wellness visits and meeting regularly with healthcare providers and diabetes educators can help monitor risk factors for cardiovascular-kidney-metabolic syndrome and identify steps to take to reduce your risk of progression. 

Learn more about cardiovascular-kidney-metabolic health: