Combination of Cardiovascular, Kidney, and Metabolic Diseases in a Syndrome Named Cardiovascular-Kidney-Metabolic, With New Risk Prediction Equations

Abstract

Associations of chronic kidney disease (CKD) with metabolic syndrome and cardiovascular disease have long been recognized. Until recently, however, taking into account such associations was mainly limited to interrationships between either heart and kidney, heart and metabolic syndrome, or metabolic syndrome and kidney. It is the merit of the American Heart Association (AHA) to have set up a work group of cardiologists, endocrinologists and nephrologists for the purpose to combine all three disorders in a single entity, as an appreciation of their pathophysiological interrelatedness. To this end, they proposed the term Cardiovascular-Kidney-Metabolic syndrome (abbreviated term, CKM syndrome) in order to reflect multidirectional relationships among metabolic risk factors, CKD, and the cardiovascular system. Following a consensus approach in defining CKM with 5 stages, the work group subsequently developed new risk prediction equations, named Predicting Risk of CVD EVENTs (PREVENT) equations, which included estimated glomerular filtration rate and albuminuria as variables in addition to traditional cardiovascular and metabolic factors. Despite several limitations this development is a major step forward in cardiovascular risk prediction. Its clinical application should translate into earlier, more appropriate treatment and prevention of CKM syndrome.It has long been known that chronic kidney disease (CKD) is frequently observed in association with metabolic syndrome, cardiovascular disease, or both. Sorting out the directionality of the relationship is sometimes easy. As an example, in patients with primary forms of chronic glomerulonephritis cardiovascular disease is most often secondary to kidney disease. In contrast, in patients with metabolic syndrome, diabetes or cardiovascular disease (CVD) the development of kidney disease is most often a secondary event. However, in many instances the sequence of events is more difficult, if not impossible to establish. In any case, one would always like to know which came first, the egg or the chicken. The answer to this question is of importance not only from a theoretical, pathophysiological point of view, but also from a practical, clinical point of view. Better knowledge can lead to improved, individualized disease management.