What is cardiovascular-kidney-metabolic (CKM) syndrome?
Click to see answer
Cardiovascular-kidney-metabolic (CKM) syndrome is a new entity that emphasizes interconnections among atherosclerotic cardiovascular disease (ASCVD), atrial fibrillation (AF), heart failure (HF), chronic kidney disease (CKD), excess adiposity, metabolic syndrome, and diabetes. It is categorized into five stages, reflecting the progressive nature of the pathophysiology behind this multifaceted syndrome and the increasing risk of adverse cardiovascular outcomes associated with higher CKM stages.
Click to see question
What is cardiovascular-kidney-metabolic (CKM) syndrome?
Cardiovascular-kidney-metabolic (CKM) syndrome is a new entity that emphasizes interconnections among atherosclerotic cardiovascular disease (ASCVD), atrial fibrillation (AF), heart failure (HF), chronic kidney disease (CKD), excess adiposity, metabolic syndrome, and diabetes. It is categorized into five stages, reflecting the progressive nature of the pathophysiology behind this multifaceted syndrome and the increasing risk of adverse cardiovascular outcomes associated with higher CKM stages.
What are the challenges in patient care related to CKM health?
Challenges in patient care related to CKM health include:
What is the role of screening in the CKM health framework?
Screening asymptomatic individuals for metabolic risk factors is a key component of the CKM health framework. Important metabolic risk factors include:
What is the recommended blood pressure threshold for defining hypertension according to the CKM framework?
The CKM framework utilizes a lower threshold of 130/80 mm Hg based on recent evidence.
Why is early detection of CKM risk factors emphasized in the CKM health framework?
Early detection aligns with the Primary Healthcare Blueprint and aims to reduce complications such as CKD, cardiovascular disease (CVD), and hospitalizations.
What role do nephrologists play in the management of CKM syndrome?
Nephrologists manage individuals across CKM stages and are crucial in addressing the increasing incidence of kidney failure and the healthcare burden of CKD.
What is the significance of testing for cardiac biomarkers like BNP and troponin in at-risk individuals?
Testing for cardiac biomarkers helps detect subclinical heart failure and guides therapies, particularly in patients with CKD.
What is the CKM staging system's approach to cardiovascular risk factors?
The CKM staging system prioritizes early detection of cardiovascular risk factors, recommending eGFR and urine albumin-to-creatinine ratio assessments for at-risk individuals.
What preventive measures are suggested for individuals with early CKD?
Preventive measures include timely screening and management of CKM risk factors to prevent clinical ASCVD, AF, HF, and kidney failure.
What is the RAMP Programme and its significance in managing hypertension and diabetes?
The RAMP (Risk Assessment and Management Programme) is designed for managing hypertension and diabetes, allowing for treatment even before metformin is prescribed in individuals with glycated hemoglobin levels <7.5%. It emphasizes the importance of regular screening for complications in patients with diabetes, including cardiovascular risk assessments and urine albumin-to-creatinine ratio testing.
What are the recommended screening methods for CKD according to the CKM framework?
The CKM framework recommends screening for CKD before age 21 years among individuals with risk factors such as obesity, hypertriglyceridaemia, diabetes, or hypertension. It highlights the need for early detection to improve kidney survival and quality of life, particularly in high-risk groups.
What role do primary care and family doctors play in CKM management?
Primary care and family doctors are crucial in CKM management by ensuring regular follow-up, monitoring glycaemic status, lipid profiles, and blood pressure, and surveilling for CKM complications such as CKD progression or clinical CVD.
What are the key components of the interdisciplinary care model for CKM health in Hong Kong?
The interdisciplinary care model for CKM health in Hong Kong includes guideline-directed management approaches, monitoring of anthropometric thresholds, and the use of kidney-protective therapies that also provide cardiovascular benefits, such as ACE inhibitors or ARBs, sodium-glucose co-transporter 2 inhibitors, and GLP-1 receptor agonists.
What challenges does the CKM health framework face in Hong Kong?
The CKM health framework in Hong Kong faces challenges such as discrepancies in drug formularies between primary care and specialty clinics, inadequate coordination between services, and limited access to newer CKM pharmacotherapies, which can hinder timely treatment and management of patients.
What is the significance of viewing dyslipidaemia, obesity, and kidney insufficiency as chronic conditions in CKM syndrome?
Dyslipidaemia, obesity, and kidney insufficiency should be viewed as chronic conditions requiring early intervention to prevent cardiovascular disease (CVD) and chronic kidney disease (CKD). This perspective emphasizes the need for ongoing management rather than treating them solely as risk factors.
What are the strengths of the Hong Kong health system in implementing the cardiovascular-kidney-metabolic health framework?
The strengths include:
What limitations exist in the Hong Kong health system regarding CKM syndrome management?
Limitations include:
What is the role of the Chronic Disease Co-Care Pilot Scheme in managing CKM syndrome?
The Chronic Disease Co-Care Pilot Scheme provides targeted subsidies to support the diagnosis and management of chronic diseases, particularly hypertension and diabetes, in the private sector. This co-care model aims to benefit patients across various CKM stages and mitigate complications.
How does the HKCP propose to improve CKM syndrome management?
The HKCP emphasizes the need for collaborative interdisciplinary care, education for the public and healthcare professionals, integrated care across primary and specialist services, and a focus on organ protection. This approach aims to address the growing challenges of CKM syndrome and improve cardiovascular, metabolic, and kidney health in the community.
What are the key contributions of the authors in the study?
The authors contributed in the following ways:
All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.
What conflicts of interest were reported by the authors?
The following conflicts of interest were reported:
Was there any funding or support for the position statement?
The position statement was not supported by any specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
What are the key components of the evolution of diabetes care in Hong Kong as discussed in the literature?
The evolution of diabetes care in Hong Kong includes:
What are the predictors and determinants of albuminuria in individuals with prediabetes and diabetes?
The study on predictors and determinants of albuminuria in individuals with prediabetes and diabetes highlights:
What is the significance of the 2018 AHA/ACC guideline on blood cholesterol management?
The 2018 AHA/ACC guideline on blood cholesterol management emphasizes:
What are the implications of the WHO Expert Consultation on body-mass index for Asian populations?
The WHO Expert Consultation on body-mass index for Asian populations suggests:
What are the findings regarding racial differences in the cholesterol-lowering effect of statins?
The findings on racial differences in the cholesterol-lowering effect of statins indicate:
What are the stages of cardiovascular-kidney-metabolic syndrome proposed by the American Heart Association?
| CKM Stage | Cardiovascular Condition | Kidney Condition | Metabolic Condition |
|---|---|---|---|
| Stage 0 | No subclinical or clinical ASCVD, HF, or AF | No evidence of CKD | Normal BMI and WC based on ethnicity-specific thresholds, FG <5.6 mmol/L, HbA1c <5.7%, SBP <130 and DBP <80 mm Hg, TG <1.52 mmol/L |
| Stage 1 | No subclinical or clinical ASCVD, HF, or AF | No evidence of CKD | Overweight or obesity, FG 5.6 and ≤6.9 mmol/L, HbA1c ≥5.7% and <6.4% |
| Stage 2 | No subclinical or clinical ASCVD, HF, or AF | CKD stage 3 with normoalbuminuria | Diabetes, Hypertension, CKD stages 1-3a with moderately increased albuminuria, TG ≥1.52 mmol/L, presence of metabolic syndrome |
| Stage 3 | Subclinical ASCVD, subclinical HF | CKD stage ≥4, CKD stage 3b with moderately increased albuminuria | Presence of excess or dysfunctional adiposity, or metabolic risk factors |
| Stage 4 | Clinical ASCVD, HF, or AF | Any CKD, CKD stage 4a or 4b | Presence of excess or dysfunctional adiposity, or metabolic risk factors |
What screening intervals are recommended for different stages of cardiovascular-kidney-metabolic syndrome?
What is the purpose of the PREVENT equation in the context of CKM management?
The PREVENT equation estimates overall CVD risk and guides preventive therapy initiation, particularly in asymptomatic individuals without ASCVD or HF.
