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1yr
CKM syndrome is associated with increased CVD risk

Many times, cardiovascular, metabolic, and kidney diseases occur together. Health and mortality risks are amplified in individuals with more than one of these conditions. The commonly occurring triad is now defined as its own entity, namely cardiovascular-kidney-metabolic (CKM) syndrome.

The pathophysiology of CKM syndrome involves complex molecular mechanisms interconnected through various pathways. CKM syndrome affects almost every major organ system, but its biggest effect is its inordinate burden of cardiovascular disease (CVD). Impaired kidney function is a central mechanism of heart failure and metabolic risk factors; thus, as CKM syndrome progresses, the risk of CVD increases. Sudden cardiac death, atrial fibrillation, stroke, coronary heart disease, and peripheral artery disease have all been linked to CKM syndrome.

The obvious consequence of this increased risk of CVD is reduced survival rates, so there is a critical need for HCPs to intervene with at-risk patients and to do so quickly. Proactive screening is critical to identifying patients with CKM syndrome, particularly in the earlier stages of the disease. Linkage of care is also important so that HCPs can holistically address lifestyle modifications, preserve existing renal function, help prevent kidney failure, and identify patients who require additional interventions.

How do you stress the link of cardiovascular and metabolic diseases in your patients with impaired kidney function? What barriers to care linkage do you see in your clinical practice?

  • 1yr
    I will now share with my patients the fact that CKM raises the stakes with regard risk status.
  • 1yr
    I tend to be blunt rather than beating around the bush when it comes to CKM because the stakes are high. I let patients know that as their kidney function decreases, their chance of MI, stroke, heart failure and arrhythmias goes through the roof. I discuss how it is imperative that we stop further progression of the kidney function loss in order to minimize this risk.

    One of the biggest barriers is cost of medications. If a patient is non-diabetic, it is very difficult to get a prescription for an SGLT-2 or GLP-1 covered. Both of these classes have good data on their renal protective properties, but cost and insurance coverage is often prohibitive. This is especially true for the age group who is most affected: the elderly on Medicare.
  • 1yr

    kidney function with levels with,glucose and insulin levels catches diseases in early stages which prevent vascular diseases.
  • 1yr
    Increased risk for Heart failure, hospitalizations as well as possible microvascular damage leading to CVA, TIA’s amd
  • 1yr
    After diagnosing patient with diabetes and CKD I discuss patient the increase risk to their health. We then try to reduce their risk with controlling the disease process. Medication can be reduce risks more
  • 1yr
    It is daily discussion with patients about the major players involved in these disease processes. Importance of cholesterol, blood pressure, glucose control, and tobacco cessation. LDL reduction, Glucose reduction, weight loss. Availability of SGLT-2 and GLP-1 medications have been helpful for disease modification/improvement.
  • 1yr
    I tell all patients with diabetes, that there is micro and macrovascular disease complications that can occur. I tell them with good glucose management, we hope to present or slow renal disease and that if I control blood pressure and glucose, these will be helpful, but I have medications that can help delay and worsening of it, SGLT2, GLP-1, ACEI/ARB and these can help prevent heart disease as well. Also, those with microalbuminuria are at much higher risk for CAD and they are linked and I treat them particularly aggressive. Barriers are cost of these new medications and getting patients to f/u regularly.
  • 1yr
    I always explain that the renal and cardiac systems are dependent on each other. Therefore I explain that we have to treat all aspects of both systems.
  • 1yr
    Educating patients about the link between cardiovascular and metabolic diseases in the context of impaired kidney function is extremely crucial. I usually explain that chronic kidney disease (CKD) can lead to changes in the body's metabolism and mineral balance, which can contribute to cardiovascular disease. I also stress the importance of managing traditional cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia, which are often present in patients with CKD and can further increase their cardiovascular risk.
    In terms of barriers to care linkage, there are several that I commonly encounter in clinical practice. These include: 1. Lack of patient understanding of linkage of CKD and CVD. This can make it difficult for them to appreciate the importance of adhering to their treatment plan. 2. Socioeconomic factors: Some patients may have difficulty affording medications or making necessary lifestyle changes due to financial constraints or lack of social support. 3. There can be a lack of coordination between different healthcare providers, which can lead to fragmented care. 4. Psychological factors: The diagnosis of CKD and its complications can lead to significant psychological stress, which can impact a patient's ability to adhere to their treatment plan
  • 1yr
    I always let my patients know that these comorbidities are all interrelated. That if they have chronic kidney disease, that the chances for having a cardiovascular event is much more likely than developing endstage kidney disease. This is the reason why I am a proponent of early use of Glucagon like peptide 1 agonists, and SGLT-2 inhibitors. These will help diabetes, improve weight, with salutary effects on blood pressure lowering, decrease progression of CKD
  • 1yr
    is done through education most of these patients are seen every 3 months and I reviewed her blood work with them and talk about the high risk that the patient has diabetes his with respect to cardiovascular disease and events stroke goal for LDL less than 70 and increased risk for cardiovascular disease and chronic renal disease patient need to monitor her blood sugar her blood pressure and consider medication such as HEENT 2 inhibitors and GLP-1 class to help reduce the risk as well as improving glycemic control and keep her weight down
  • 1yr
    by educating the patient about the causal relationship between these conditions
    barriers would be time constraint as well as lack of specific guideline to manage such condition
  • 1yr
    I think that it's all linked together. I always discuss with my patients the importance of a risk lowering lifestyle and negative impacts if they fall short of this. Early intervention and early treatment is so important on reduction of mortality and morbidity.
  • 1yr
    I discuss with them that the organs/systems are all interrelated and all need to function properly-especially in Diabetics
    Prevention of disease and early intervention are key…non compliance and not being proactive in their healthcare cause resistance among patients
  • 1yr
    It is very important to asses all cardiovascular risk factors, have dm, lipids, bp controlled, avoid progression ckd , to improve mortality.
  • 1yr
    Most of my patients at risk are those with type 2 diabetes. I do try to stress the positive, with proper care, including these new medications, we can really affect positive outcomes including the most common complication, CV death. I do agree with the previous post that medication access is a critical problem for some of our patients.
  • 1yr
    I routinely discuss the risk of CVD with all my pts diagnosed with CKD. Many pts still cannot afford the appropriate medications and very reluctant to add additional medications to decrease CVD risk once the diagnosis of CKD is established. It is important to bring back this conversation at every visit until pts can trust you and follow your recommendations. Access to SGLT2i is also improving every month and frequently we have to send prescriptions multiple times, all these meds are requiring a prior auth.
  • 2yr
    CKD and risk of CVD always has been there and there has been an emphasis on the LDL reduction optimally less than 70 and BP less than 130/80 along with the optimum weight reduction and adopting healthy life style with diet and exercise but with the SGLT-2 inhibitors and GLP-1 class of meds improvement in the CVD outcomes has gone to a whole different level in the perspective of CKD and very rightly so the CKM nomenclature has come up Most likely these meds have such a great impact is due to weight reduction and the improvement of the BP am sure there are some other molecular level changes that take place with these meds intrinsically ! Challenge is always there to proactively convince the pts with CKD that they need another med to prevent the long term risk of CVD and it has to be balanced with the potential side effects cost , poly pharmacy and drug interactions but i guess as the awareness increases among the general public about the efficacy of these meds our job will become easier to introduce these meds due course of time
  • 2yr
    Whenever I diagnose a patient with adult onset, diabetes, which is fairly common, I tell them we need to be monitoring three important things. It’s not just about the sugar. I discuss the cholesterol, blood, pressure, and sugar. I also discuss how these three things conspire to hurt the major organs in the body like the kidney.

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