90% of U.S. Adults Have CKM Syndrome. Here's What That Means

A new study shows that almost 90% of U.S. adults may have cardiovascular-kidney-metabolic (CKM) syndrome, a condition that can elevate the risk of several major health problems. While this statistic may sound alarming, the good news is that there are new therapies to help support people with CKM.

If you are unfamiliar with CKM syndrome or were told that you have it, this article will help you better understand what it is and how to manage it—including through your diet.

What Is CKM Syndrome?

CKM syndrome is a relatively new term coined by the American Heart Association in 2023. It represents an interconnected cluster of conditions: cardiovascular disease, chronic kidney disease, and metabolic disorders such as diabetes and obesity.

The presence of one condition often exacerbates the others, creating a vicious cycle that complicates management and treatment. For instance, hypertension and diabetes are common precursors to kidney disease, while kidney dysfunction can, in turn, increase cardiovascular risks.

“Cardiovascular, kidney, and metabolic diseases are all hugely problematic in the United States,” Will Bulsiewicz, MD, medical director of personalized nutrition and health test company Zoe, told Verywell.

“The reason to bring these three separate systems together is that they share common origins," he added. "They are substantially interrelated to the point that if you try to improve one, there is a strong likelihood of improving others simultaneously. Basically, they rise together and they fall together. What we want is to vanquish or reduce all of them at the same time.”

Most Americans Are in Stage 1 or 2

Few studies have evaluated CKM syndrome stages in the U.S. population, making it challenging to understand how prevalent or severe this condition is. 

To fill this knowledge gap, researchers evaluated data from the National Health and Nutrition Examination Survey (NHANES)—a nationally representative survey of the U.S. population. Using data from 10,762 adults aged 20 years or older surveyed from 2011 to 2020, the researchers were able to place Americans into stages:

• Stage 0: 10.6% of Americans. No risk factors (normal BMI and waist circumference, normal blood sugar, normal blood pressure, normal lipid profile, and no signs of chronic kidney or cardiovascular disease)
• Stage 1: 25.9% of Americans. Overweight or obesity, excess abdominal fat, and/or impaired glucose tolerance or prediabetes, without other metabolic risk factors or chronic kidney disease
• Stage 2: 49% of Americans. Metabolic risk factors (such as high triglycerides, high blood pressure, and diabetes) or chronic kidney disease
• Stage 3: 5.4% of Americans. Atherosclerotic cardiovascular disease or heart failure in individuals with excess body fat despite a lack or symptoms, other metabolic risk factors, or chronic kidney disease
• Stage 4: 9.2% of Americans. Coronary heart disease, heart failure, and stroke in individuals with excess body fat, chronic kidney disease, or other CKM-related risk factors. This stage is further divided into stage 4a for patients without kidney failure and stage 4b for patients with kidney failure.

Sex, race, and age all impact prevalence. Compared to women, men were more likely to have advanced CKM syndrome stages. Black adults were significantly more likely to have advanced stages than White adults. And older adults tend to experience later stages of CKM syndrome, too.

"The study has some limitations, of course—such as relying on self-reported survey data,” Chrissy Arsenault, RDN, a registered dietitian at Trainer Academy, told Verywell. “The response rate decreased significantly from 2011 to 2020, and adjustments to the parameters were necessary to continue the study.”

When Is Your CKM Stage a Concern?

The four stages of CKM are established with specific criteria. But at which stage should you be concerned? 

“Based upon this new research, it is suggested that most of us who are reading this article have stage 1 or 2 CKM syndrome,” Bulsiewicz said. He explained that while you may feel perfectly normal when experiencing these stages, “having CKM at any stage is indicative of metabolic dysfunction and is abnormal.”

Correcting stages 1 or 2 is crucial to stopping disease progression, and preventing chronic conditions that can lead to an early death.

How to Manage CKM Syndrome

Managing CKM syndrome requires a multifaceted approach that addresses the interconnectedness of these systems.

Lifestyle modifications are paramount. A heart-healthy diet rich in fruits, vegetables, lean proteins, and whole grains can significantly improve overall health. Reducing sodium intake and limiting processed foods can alleviate the strain on both the cardiovascular and renal systems.

Regular physical activity, such as walking, cycling, or swimming, is equally critical for maintaining cardiovascular health and metabolic balance. Smoking cessation and moderate alcohol consumption are also vital steps in mitigating the risk factors associated with CKM syndrome.

Bulsiewicz shared that using an individualized guided nutrition program, like ZOE, may be a viable solution as well. Data provided and analyzed by ZOE evaluated 347 Americans representative of the average U.S. population, meaning that most of them had CKM syndrome.

“They either followed the ZOE program or the U.S. Dietary Guidelines,” Bulsiewicz said. “By following the ZOE program, people significantly improved their body weight, waist circumference, and blood sugar control. Those who closely followed the ZOE program experienced even better improvements, including lower diastolic blood pressure and lower blood fat levels. This encompasses many of the conditions that define stage 2 CKM syndrome.”

In addition to lifestyle changes, medical management plays a crucial role. Regular monitoring of blood pressure, glucose levels, and kidney function is essential for early detection and intervention. Working closely with healthcare providers to tailor treatment plans to individual needs is crucial for effective management, and medication may be prescribed.

Commonly prescribed medications may include antihypertensives like angiotensin-converting-enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which help control blood pressure and reduce kidney damage. Diuretics may also be used to manage fluid retention. Statins are often prescribed to manage cholesterol levels, reducing cardiovascular risks. Some people with CKM syndrome may be told to avoid non-steroidal anti-inflammatory drugs (NSAIDs) as they may exacerbate kidney damage.

Coordinated care involving cardiologists, nephrologists, and endocrinologists can provide comprehensive management and significantly improve outcomes for individuals with CKM syndrome.