CKM Syndrome: Why Heart, Kidney, Metabolic Disorders Must Be Treated Together

For the past five years, factory manager Joseph Lee has been living with diabetes, high blood pressure and obesity. 

But when he was diagnosed with kidney failure in January this year, his biggest worry was not just his health but how he would continue working and providing for his family.

Lee, 45, who lives in Gombak, Selangor, faced the prospect of undergoing regular dialysis while maintaining his daily commute to work in Selayang, Selangor.

“My unhealthy eating habits, lack of exercise, excess weight and insufficient rest contributed to my diabetes and high blood pressure,” the father of two told Bernama recently.

On his doctor’s advice, he opted for home-based peritoneal dialysis, which allowed him to undergo treatment for 10 hours every night while he slept, instead of going to the hospital for dialysis. As a result, he could keep working during the day to support his family.

“Honestly, I never thought my diabetes and high blood pressure could lead to kidney failure,” he sighed. 

Lee’s experience highlights how chronic conditions such as diabetes, obesity and hypertension can have far-reaching consequences, particularly when they begin to affect other organs.

“Now, I have to watch my daily diet,” he said. “I’m also avoiding working overtime and am doing light exercises at home, with the help of my wife,” he said. 

Patients with kidney failure can opt for home-based peritoneal dialysis or hospital dialysis

CKM SYNDROME 

Obesity and diabetes are often regarded as separate health problems, but medical experts warn that these conditions are closely interconnected with complications affecting the heart, kidneys and metabolic system. 

This relationship is gaining attention through a medical framework known as cardiovascular-kidney-metabolic (CKM) syndrome, which recognises how metabolic risk factors, cardiovascular disease and kidney dysfunction influence one another.

Dr Sabrina Nordin, a consultant cardiologist at Hospital Picaso, a private hospital in Petaling Jaya, said the concept was not entirely new as doctors had long recognised the relationship among diabetes, cardiovascular disease and kidney problems.

She said traditionally, patients with diabetes, kidney disease and cardiovascular problems were often treated separately by different specialists.

“What has changed is the growing emphasis on identifying and managing these conditions together, rather than treating each as separate diseases.

“Obesity, for instance, can contribute to insulin resistance and eventually type 2 diabetes, which increases the risk of damage to blood vessels supplying the heart and kidneys.

“Meanwhile, kidney dysfunction can contribute to high blood pressure and place additional strain on the heart, creating a vicious cycle that becomes increasingly difficult to manage,” she told Bernama in a Zoom interview recently. 

She said over time, diabetes and high blood pressure can damage blood vessels and the kidneys, while declining kidney function can place further strain on the cardiovascular system.

“The concern is not limited to older adults because now obesity and diabetes are even affecting Malaysians at younger ages, potentially exposing them to serious complications much earlier in life,” she said. 

Diabetes and high blood pressure, which mostly occur in patients with obesity, can damage blood vessels and the kidneys

SILENT HEALTH THREAT

Hospital Picaso consultant endocrinologist Dr Sharmila Sunita Paramasivam said that with approximately half of Malaysian adults classified as overweight or obese, early screening and timely intervention are crucial to prevent the progression of these interconnected conditions.

She said what makes CKM syndrome particularly concerning is that many of the underlying risk factors may develop without obvious warning signs. 

“Diabetes patients may not experience noticeable symptoms, especially during the early stages of their diagnosis.

“As a result, some patients may only discover their condition during routine health screening or when complications begin to develop,” she said, adding that obesity, diabetes, hypertension and abnormal cholesterol levels are among the important risk factors associated with CKM syndrome.

However, not everyone with these conditions will necessarily develop heart or kidney disease, particularly if the risk factors are identified and managed early.

“Obesity and diabetes are increasingly being seen among younger people, raising the possibility of serious health complications developing earlier in life and making early detection particularly important,” Dr Sharmila said, adding that metabolic problems can develop long before a person experiences symptoms of cardiovascular or kidney disease. 

Hospital Picaso's consultant Cardiologist, Dr Sabrina Nordin (left) and consultant endocrinologist Dr Sharmila Sunita Paramasivam (left). (Pix credit to Hospital Picaso)

Sharing a similar concern, Cardiac Vascular Sentral Kuala Lumpur (CVSKL) consultant interventional cardiologist Dr Wan Faizal Wan Rahimi Shah said CKM syndrome usually develops gradually, with damage to the heart and kidneys potentially occurring over several years.

He said it is difficult to determine exactly when the heart and kidneys would be affected, although poorly managed risk factors could accelerate organ damage.

“The early stage, known as Stage 1, includes people with excess weight or unhealthy fat distribution and those with insulin resistance or pre-diabetes. 

“Most people will miss all of them (symptoms) as they are almost always asymptomatic; the few who discover that they are in this stage are those who regularly undergo health screenings,” he said. 

Dr Wan Faizal Wan Rahimi Shah (pix credit to CVSKL)

NOT JUST ABOUT BODY WEIGHT

Although obesity is a major risk factor for CKM syndrome, doctors caution that body weight alone does not provide a complete picture of a person’s metabolic health.

Asians may develop metabolic complications at lower body mass index (BMI) levels than some other populations, according to Dr Sharmila.

“Under commonly used Asian BMI classifications, a BMI of 23 or above is considered overweight, while a BMI of 27.5 or above indicates obesity.

“However, BMI is not the only factor to consider as excess fat around the abdomen could also increase the risk of metabolic complications,” she said. 

Dr Wan Faizal agreed, saying that individuals who do not appear visibly overweight may still have underlying metabolic risk factors, especially if they carry excess abdominal fat.

He said visceral fat, which accumulates deep inside the abdomen and surrounds internal organs, is particularly concerning because of its association with cardiovascular disease.

“Visceral fat is a strong, independent predictor of cardiovascular disease. Excessive visceral fat could trigger chronic low-grade inflammation, promote insulin resistance and metabolic dysfunction, as well as increase the workload on the cardiovascular system.

“These changes could gradually contribute to the development of diabetes, high blood pressure and cardiovascular disease,” he explained. 

Visceral fat is a strong, independent predictor of cardiovascular disease (Pix credit: Ideal Dexa Clinic)

Dr Wan Faizal added that assessing visceral fat could provide a more meaningful indication of cardiovascular risk than relying solely on BMI.

 “Other contributing factors include family history, unhealthy dietary habits, physical inactivity, inadequate sleep and chronic stress,” he said. 

BREAKING THE VICIOUS CYCLE

Despite the potential complications associated with CKM syndrome, Dr Sharmila said early intervention could help reduce the risk of disease progression.

“Improvements in weight management, dietary habits and physical activity could have significant benefits for individuals with obesity, pre-diabetes and type 2 diabetes.

“For some patients, sustained weight loss and appropriate treatment may improve blood sugar control and, in certain circumstances, lead to diabetes remission,” she said. 

She said alongside lifestyle modifications, medical treatment may be necessary depending on a patient’s condition and risk factors.

“Certain medications such as Ozempic and Mounjaro, used to manage diabetes and obesity, have also demonstrated cardiovascular or kidney benefits in specific patient groups.

“However, these medicines should only be used under proper medical supervision,” she said. 

Diabetes and Hypertension patients are advised to seek medical checkups frequently

Dr Wan Faizal said treatment would become more challenging as CKM syndrome progresses, particularly when patients develop established cardiovascular disease.

He said Stage 4 represents the most advanced stage of CKM, when clinical cardiovascular disease is already present.

“At this stage, damage to the heart, kidneys or other organs could be permanent, making early intervention particularly important.

“For individuals who already have obesity or diabetes but whose heart and kidney tests remain normal, the priority should be preventing further progression through appropriate medical care.

“Therefore, treatment should be tailored to the individual’s health condition and risk factors,” he said. 

MORE COORDINATED APPROACH

Dr Sabrina, meanwhile, added that closer coordination among healthcare professionals is essential to managing CKM syndrome effectively.

She said the interconnected nature of cardiovascular, kidney and metabolic conditions meant that patients could benefit from a more comprehensive approach involving different medical disciplines.

“Instead of treating diabetes, hypertension, kidney dysfunction and cardiovascular disease separately, doctors should consider how each condition could influence the others,” she said. 

Dr Wan Faizal said managing CKM syndrome ideally required coordination among cardiologists, nephrologists, endocrinologists and primary care doctors.

However, he pointed out that in Malaysia, general practitioners continue to shoulder much of the responsibility for managing patients with these conditions.

“Patients might initially seek treatment from different specialists, depending on which health problem is detected first.

“As such, timely referrals to the appropriate specialists are important, especially when patients require more complex or individualised treatment,” he said.