Cardio-kidney-metabolic syndrome

A Black female physician consults with a patient in an office setting.

The increasing prevalence of cardio-kidney-metabolic (CKM) syndrome and its associated morbidity and mortality call for a paradigm shift in primary care.

Nearly 50% of U.S. adults have hypertension, the leading preventable risk factor for heart disease, stroke, kidney disease and dementia.

Nearly 90% of adults meet criteria for CRM risk, contributing to substantial morbidity, mortality and financial burden. (Journal of Cardiac Failure – Intersections)

Yet major gaps persist in multi-morbidity care, including coordinated care management, early detection across disease types, diagnostic confidence, obesity care and effective multidisciplinary collaboration.

As family physicians, you are on the front line of CKM—integrating cardiovascular, kidney, and metabolic care at every visit. Acting early and in a coordinated way improves outcomes, reduces fragmentation and lowers cost while supporting continuity across the patient’s lifespan.

Clinical overview

CKM syndrome is a systemic disorder that arises from pathophysiologic interactions among excess or dysfunctional adiposity, metabolic risk factors, chronic kidney disease (CKD) and the cardiovascular system. These conditions amplify one another and, when combined, lead to multiorgan dysfunction, higher rates of adverse cardiovascular outcomes and increased mortality. More detailed information on the prevention, detection, evaluation and management of CKM syndrome is available in the American Heart Association/American College of Cardiology guideline, developed in collaboration with other medical societies.

CKM toolkit informational guides with charts, staging, and essential 8 guidance.

Predicting Risk of Cardiovascular Disease EVENTs (PREVENT)

CKM toolkit informational guides with charts, staging, and essential 8 guidance.

ABCs = A1C, blood pressure and cholesterol; ASCVD = atherosclerotic cardiovascular disease; CKD = chronic kidney disease; CKM = cardio-kidney-metabolic; CVD = cardiovascular disease; MI = myocardial infarction; PAD = peripheral artery disease.

*Examples of guideline-directed medical therapy used in appropriate patients with CKM syndrome include an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, a sodium-glucose cotransporter-2 inhibitor, a glucagon-like peptide 1 receptor agonist and a nonsteroidal mineralocorticoid receptor antagonist.

This section contains excerpts from a full CKM overview guide.
Read the full overview

Shared decision-making

In primary care, addressing CKM health involves more than identifying risk. It also requires understanding your patient’s priorities, challenges and readiness to change. You can use this resource to guide the conversation and move toward a practical, individualized care plan.

Learn how to improve the facilitation of shared decision-making between patients and clinicians to align treatment with patient preferences and goals.

Key patient information to document

  • Biggest current day-to-day challenges (e.g., symptoms, logistics, adherence, cost, access, health literacy)

  • What has been tried, what helped and what did not help (e.g., lifestyle changes, medications)

  • Support system

  • Adverse social determinants of health (e.g., economic instability, food insecurity, transportation barriers)

  • Patient‑stated goals for the next one to three months (i.e., what “better” looks like)

Assess

Clarify the patient’s current clinical status and the main factors driving their CKM risk and disease burden.

Set a focus for the visit:

  • Determine where the patient falls on the CKM syndrome staging spectrum.
  • Explain their top one or two near‑term risks in plain language (e.g., “Your blood pressure is elevated today. If this continues, it can increase your risk of heart disease, stroke and heart failure.”).
  • Identify the main focus of today’s visit.

Discuss

Use focused conversation prompts to explore the patient’s experiences, priorities, challenges and questions. Choose those most relevant to the patient’s main CKM drivers and the time available for today’s visit.

Decide

Choose one or two practical next steps based on the patient’s main CKM drivers, current clinical status, priorities and readiness to change.

Lifestyle options to discuss

Use the American Heart Association’s Life’s Essential 8 to frame counseling about lifestyle changes that address CKM risk factors.

CKM toolkit informational guides with charts, staging, and essential 8 guidance.

Concluding the visit

  • Before concluding the visit, answer your patient’s questions and use a brief teach-back to confirm their understanding of the plan and any medication changes.

This section contains excerpts from a CKM shared decision-making guide.
Read the full shared decision-making guide

This content was independently developed by the AAFP with support provided by Bayer.