Cardiovascular-kidney-metabolic (CKM) health reflects the close interplay between metabolic risk factors, chronic kidney disease (CKD) and the cardiovascular system.¹ Poor CKM health can lead to multi-organ dysfunction and favor the development of CKM syndrome, a health disorder due to connections among heart disease, kidney disease, diabetes, and obesity.¹ CKM syndrome is disproportionately seen among those with unfavorable conditions for lifestyle and self-care resulting from societal factors, economics, and the environment.¹ Fragmented patient care involving multiple providers, long wait times for specialist visits, and a lack of cohesive treatment plans are also major barriers to enhancing CKM health in the population.¹

As such, the American Heart Association (AHA) launched the AHA CKM health initiative which aims to improve CKM health by providing guidance on the definitions, staging, risk prediction, and prevention and management strategies for CKM syndrome.¹ At the ASN Kidney Week 2023, Professor Glenn Chertow from Stanford University School of Medicine in the United States (US) shared the rationale, objectives, and key areas of focus of the initiative.¹

The AHA has further classified CKM syndrome into 4 stages, where stages 1 to 4 represent the presence of excess/dysfunctional adipose tissue, metabolic risk factors (hyper-triglyceridemia, hypertension, type 2 diabetes, metabolic syndrome) and CKD, subclinical CVD in CKM syndrome, and clinical CVD in CKM syndrome respectively.¹ Staging of the syndrome offers a reflection of the pathophysiology underlying CKM progression and facilitates the identification of participants with under-recognized clinical conditions and elevated clinical risks. Each stage represents a higher level of absolute clinical risk, with a principal focus on CVD to define the “at-risk” population and to identify those with end-organ injury.¹ Each stage also represents a particular window for intervention to prevent progression to later stages of CKM syndrome and support the concept of stage regression.¹ Prof. Chertow also highlighted the importance of reviewing AHA’s Life’s Essential 8 (eating better, being more active, getting healthy sleep, managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure) with patients in preventing and preserving cardiovascular health.¹

Screening for CKM risk factors is also recommended in both youth and adults which will allow preventive interventions to be implemented early.¹ For individuals aged <21 years, annual screening for weight and blood pressure assessment starting at age 3 is recommended.¹ Other recommended early life assessments include mental and behavioral health screening, fasting lipid panel between ages 9-11 and 17-21, and monitoring of glucose intolerance and alanine aminotransferase levels.¹ In individuals aged ≥21 years, annual screening of body mass index and waist circumference annually is recommended, accompanied by measurements for blood pressure, hemoglobin A1c (HbA1c), lipid panel, microalbumin and creatinine at stage-determined intervals.¹ Screening for metabolic dysfunction-associated steatotic liver disease (MASLD) and coronary artery calcium (CAC) as directed by guidelines is also advised.¹

In addition to screening for biological factors, the initiative endorsed the screening for social determinants of health (SDOH) as it can be influential towards participants’ likelihood of engagement with care, access, and adherence.¹ Stabilized screening tools that can assess financial strain, education/literacy, personal safety and mental health should be used so that the appropriate interventions to address social needs can be implemented.¹

In summary, enhancing CKM health requires comprehensive, interdisciplinary care and interventions that target both individual and social factors.¹ A holistic approach involving multi-disciplinary partnerships between primary care providers, specialists, nurses, dietitians, and education specialists is critical to improve CKM health and reduce the burden of CKM syndrome.¹