Key Takeaway:
- The new guideline recommends treating heart disease, kidney disease, and diabetes together under CKM syndrome rather than as separate conditions.
- Early detection and coordinated care can help reduce the risk of heart attacks, kidney failure, and other serious complications.
- Shared therapies and routine kidney screening may improve long-term outcomes and preventive care.
A new clinical guideline published June 9 urges doctors to treat heart disease, kidney disease, and metabolic disorders as interconnected conditions under cardiovascular-kidney-metabolic syndrome, aiming to improve outcomes through coordinated care, earlier detection, and shared therapies.
Medical groups promote unified disease management
Four leading U.S. medical organizations have issued a guideline calling for a coordinated approach to managing heart disease, chronic kidney disease, and diabetes, conditions that frequently occur together and share many risk factors.
The guideline, published in the journal Circulation, was developed by the American Heart Association, the American College of Cardiology, the American Diabetes Association, and the American Society of Nephrology.
Experts say the diseases have traditionally been treated separately despite strong links among them.
“Heart disease, kidney disease, and diabetes rarely happen in isolation,” said Chiadi Ndumele, chair of the guideline writing committee and director of obesity and cardiometabolic research at Johns Hopkins Medicine. “The clinical approach has typically been to think about them in a very siloed fashion.”
The framework centers on cardiovascular-kidney-metabolic, or CKM, syndrome, a term introduced in 2023 to describe the interconnected progression of these conditions.
According to the guideline, nearly 90% of U.S. adults met criteria for at least one stage of CKM syndrome in 2020, while 15% were in advanced stages associated with higher risks of heart attack, kidney failure, and death.
Experts highlight links between conditions
Researchers say CKM syndrome(Cardiovascular-Kidney-Metabolic Syndrome) develops through a chain of related health problems affecting multiple organs and body systems.
“The heart, kidneys, and vascular system are interrelated such that abnormality in one part of the system leads to abnormalities in other parts,” said Susanne Nicholas, an adult nephrologist at the David Geffen School of Medicine at UCLA.
The syndrome often begins with obesity, particularly excess fat around internal organs. That can increase insulin resistance, raising the risk of Type 2 diabetes. Diabetes and metabolic dysfunction can contribute to high blood pressure, which damages blood vessels and kidneys.
As kidney function declines, fluid can accumulate in the body, placing additional strain on the heart and increasing blood pressure further.
The guideline follows a four-stage model first introduced in a 2023 American Heart Association advisory. Early stages include obesity and prediabetes, while advanced stages involve heart failure, coronary heart disease, stroke, and kidney failure.
“Think of CKM syndrome as a bonfire,” Nicholas said. “Obesity lights the match, diabetes fans the flame, and disease in the heart and kidneys keep the flame burning.”
Guideline expands screening and treatment
The guideline encourages broader use of treatments that benefit multiple conditions at once.
These include GLP-1 medications, which can reduce excess body fat and cardiovascular risk; SGLT2 inhibitors, which help manage Type 2 diabetes while benefiting patients with kidney disease and heart failure; and finerenone, which can slow kidney decline and reduce risks of kidney and heart failure.
“The guideline opens the pathway to a holistic, whole-person care approach rather than thinking of each system independently,” Nicholas said.
The recommendations also place greater emphasis on kidney disease screening during routine care. Experts note that many people with chronic kidney disease remain undiagnosed because early stages often produce no symptoms.
Michelle Estrella, executive director of the Kidney Health Research Collaborative at the University of California, San Francisco School of Medicine, said the framework elevates kidney health alongside hypertension and diabetes management in primary care.
The guideline also calls for screening social factors that affect health, including housing instability, food insecurity, and access to medications. Ndumele said community health workers and social workers should play a larger role in patient care.
“Addressing social risks is certainly a very big challenge,” Ndumele said, “but not one that I think we can afford to ignore.”
Source: https://www.sciencenews.org/article/heart-diabetes-kidney-disease-treatment
