Cardiovascular-Kidney-Metabolic (CKM) Syndrome

If not managed, CKM syndrome can lead to:

• Heart attack or stroke
• Worsening kidney disease or kidney failure
• Heart failure
• Nerve and eye problems 
• Lower quality of life

Your healthcare team may use different tests to find and follow health problems linked to CKM syndrome, but not everyone needs every test. Talk with your care team about what makes sense for you based on your body, health history, and risk.

Tests

Your care team may use any combination of the following tests:

• Blood pressure checks 
• Weight and waist size 
• Estimated glomerular filtration rate (eGFR) – a blood test showing how well your kidneys are cleaning waste from your blood
• Urine albumin-creatinine ratio (uACR) – a urine test checking for protein in your urine, a sign of kidney damage
• Hemoglobin A1C – a blood test showing your average blood sugar over the past few months
• Cholesterol (especially triglycerides) – a blood test measuring fats in your blood that can raise the risk of heart and blood vessel problems
• BNP/NT-proBNP – a blood test measuring a sign that your heart is under stress of working too hard
• Heart tests (like an EKG/ECG, ECHO/echocardiogram, or heart stress test), if needed – check your heart’s rhythm, strength, and structure

Overview

Treatment for CKM syndrome focuses on protecting your heart and kidneys together, not treating each condition on its own. Your care plan may include medicines, nutrition, and physical activity, working together for your overall health. 

Lifestyle Recommendations

Now is a great time to make healthier lifestyle choices, no matter what your CKM stage is:

• If you smoke or use tobacco products, stop. These can speed up the kidney disease process and increase your risk of other serious health problems, like high blood pressure, heart disease, cancer, and stroke.
• Sleeping well is important, too. Try to get enough sleep so you are well rested.
• If you have overweight or obesity, healthy weight loss using a combination of strategies can help improve your health in many ways.
• Find ways to reduce and manage stress in your life.

Nutrition

Nutrition plays a big role in CKM health. Below are some helpful steps you can take to improve your health:

• Limit salt (sodium) – too much salt raises blood pressure and causes fluid (water) buildup
• Choose healthier foods – fruits, vegetables, whole grains, and lean proteins (especially plant-based proteins) can be great options
• Watch your portion sizes – large portions can raise blood sugar and weight
• Limit sugary drinks and processed foods – these can raise blood sugar and weight without providing nutrition or health benefits
• Follow kidney-friendly advice if recommended – some people with CKD may need to change how much potassium, phosphorus, calcium, or protein they get in their diet. Work with a kidney dietitian to make a plan that works for you.

Exercise

Movement helps your heart, kidneys, blood sugar, and blood pressure.

• Aim for at least 30 minutes of exercise most days, if able
• Any type of movement helps, including walking, biking, dancing, or even household chores
• Find something you enjoy, raising your chances of sticking with it
• Break activity into shorter sessions if needed

Exercise at any level is also a great way to manage stress, which can help your heart and kidneys. 

Remember, your heart is a muscle too. Doing too much too fast can put extra strain on it. Start slow and give your body time to adjust. Always check with your healthcare team before starting a new exercise routine.

Medications

Many people with CKM syndrome take more than one medicine. Each one has a different job, and they often work best when combined with healthy eating and physical activity. 

Some medicines your care team may recommend include:

• ACE inhibitor, ARB, or ARNI – helps lower blood pressure and protect the heart and kidneys
• Anticoagulant (blood thinner) – helps prevent dangerous blood clots, especially in people with conditions like atrial fibrillation (A-fib)
• Low-dose aspirin (less than 100 mg/day) – may help prevent heart problems in some people at very high heart risk
• Diuretic (water pill) – helps your body get rid of extra fluid (water), which can make it easier for your heart to pump blood
• GLP-1 receptor agonist – helps manage blood sugar, support weight loss, slow CKD, and lower heart risk
• Metformin – helps manage blood sugar and improve how your body uses insulin, to support metabolic and heart health. If you have CKD, a lower dose of metformin may be needed, and it is generally avoided if your eGFR is below 30. 
• MRA or nsMRA – helps protect the heart and kidneys
• SGLT2 inhibitor – helps manage blood sugar and protect the kidneys and heart, even in people without diabetes
• Statin – helps lower cholesterol and lower the risk of heart attack and stroke, even in people without high cholesterol

Other medicines may also be needed to help you achieve your blood pressure, blood sugar, or cholesterol goals.