Cardiovascular-Kidney-Metabolic (CKM) syndrome is a newly defined health condition affecting nearly 90% of U.S. adults, involving interconnected risks and diseases such as heart disease, kidney disease, diabetes, and obesity1 . This syndrome reflects a complex interplay of metabolic, kidney, and cardiovascular disorders that significantly increase the risk of adverse health outcomes2 . Understanding the prevalence and early stages of CKM syndrome is crucial for timely prevention and management to reduce its widespread burden3 .
CKM Syndrome Prevalence in the US
CKM syndrome is characterized by the interaction of obesity, diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD), leading to multi-organ dysfunction and increased morbidity and mortality2 . The American Heart Association (AHA) introduced a five-stage classification system to stratify risk and guide early detection, ranging from stage 0 (no risk factors) to stage 4 (clinical CVD) 4. Nearly 90% of U.S. adults meet criteria for CKM syndrome at stage 1 or higher, highlighting the syndrome's extensive prevalence3 .
A large study using NHANES data from 1999 to 2018 assessed over 10,000 U.S. adults with a mean age in the mid-40s to determine CKM syndrome prevalence and outcomes4 5. The distribution of CKM stages in the U.S. adult population is as follows:
| CKM Stage | Definition | Approximate US Prevalence |
|---|---|---|
| 0 | No CKM risk factors | ~10% 5 |
| 1 | Excess or dysfunctional adiposity (e.g., obesity, prediabetes) | ~26% 4 |
| 2 | Metabolic risk factors and/or CKD | ~49% 45 |
| 3-4 | Subclinical or clinical cardiovascular disease | ~15% 4 |
💡 Did You Know? NCQA convened a panel of experts to begin to develop a framework for enhancing the quality of care for people with CKM syndrome21 .
Stage 0 individuals exhibit normal body mass index (BMI), waist circumference, and absence of metabolic or cardiovascular risk factors4 . Stage 1 is marked by excess or dysfunctional adiposity without CKD and affects about one-quarter of adults4 . This stage includes conditions such as obesity and prediabetes, which increase the risk for cardiovascular, kidney, and metabolic diseases2 6.
Stage 2, the most prevalent stage, affects nearly half the population and includes individuals with metabolic syndrome components and CKD2 7. Advanced stages 3 and 4 involve subclinical or clinical cardiovascular disease and comprise about 15% of adults4 . Progression along these stages is associated with increased risk of cardiovascular events, kidney failure, and mortality8 .
CKM syndrome reflects a multidirectional pathophysiology where metabolic risk factors, CKD, and cardiovascular disease interact and potentiate each other’s progression2 . This complex interplay leads to systemic inflammation, oxidative stress, insulin resistance, and vascular dysfunction, which contribute to worsening health outcomes8 .
“Screening for kidney and metabolic diseases will help us start protective therapies earlier to most effectively prevent heart disease and best manage existing heart disease.”
— Chiadi Ndumele, Johns Hopkins University8
Preventing CKM Syndrome Progression
Early CKM stages represent risk states with opportunities for prevention rather than established disease9 . Prevention focuses on identifying individuals at stages 0 and 1, emphasizing early detection and intervention to halt progression to more advanced stages6 . Lifestyle modification remains the foundation of CKM syndrome prevention and management, targeting obesity, hypertension, and diabetes10 .
“The heart, kidney and metabolic systems are connected and, as such, should be treated in a coordinated way. These results reveal the need to emphasize those connections and help patients understand the importance of collaborative care.”
— Eduardo Sanchez, American Heart Association1
Key prevention strategies include:
- Maintaining a healthy body weight through balanced diet and regular physical activity10 11
- Controlling blood pressure and blood glucose levels to reduce metabolic risk factors2 12
- Monitoring kidney function regularly to detect early CKD8
- Addressing excess or dysfunctional adiposity to prevent insulin resistance and hyperglycemia2 8
- Utilizing pharmacotherapy such as GLP-1 receptor agonists when lifestyle changes are insufficient, especially for obesity and diabetes management13
Reducing metabolic risk factors has beneficial effects on cardiovascular and kidney outcomes, breaking the vicious cycle of CKM syndrome progression2 12. Early intervention in stage 1, characterized by excess adiposity and prediabetes, can prevent or delay the onset of metabolic syndrome, CKD, and cardiovascular disease2 6.
“Lifestyle interventions, which include diet, exercise, and behavioral modification, offer potential effective approaches to prevention and treatment across the stages of CKM syndrome. These interventions address individual risk factors and contribute to overall health improvements that can slow disease progression and improve overall quality of life.”
— Summary based on14
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Public Awareness for CKM Syndrome Reduction
CKM syndrome is an emerging framework, and its natural history and progression require further study9 12. The syndrome’s complexity arises from the bidirectional interplay among metabolic, kidney, and cardiovascular risk factors, complicating causal inference and management2 15. Obesity is a key contributor but not the sole cause; some individuals develop CKM syndrome without being overweight, suggesting genetic and other factors also play roles2 67.
“We want people to know that it's really common to have heart, kidney and metabolic risk factors at the same time. It is reassuring that once the CKM connection was defined nearly three-quarters of those responding understood that it was important and wanted to learn more.”
— Eduardo Sanchez, American Heart Association1
Raising awareness among clinicians and the public is critical to improving prevention and care12 16. Currently, about 9 in 10 U.S. adults have not heard of CKM syndrome despite its high prevalence1 . Fragmented care focusing on individual diseases rather than the integrated CKM syndrome may limit effective management12 17. The CKM framework represents a paradigm shift toward multidisciplinary care of interconnected chronic diseases12 17.
Addressing social determinants of health (SDOH) is essential to mitigating disparities in CKM syndrome prevalence and outcomes16 18. Black adults and men are disproportionately represented in higher CKM stages, highlighting racial and gender disparities18 193. Early-life and prenatal interventions may be key to preventing CKM syndrome development and reducing long-term burden15 20.
Community-level interventions targeting SDOH, such as improving access to nutritious foods, safe environments, and healthcare, are vital for CKM syndrome prevention16 1819. Patients are encouraged to discuss CKM risk factors with clinicians early to enable preventive strategies12 16.
