Figure 2. Stages of CKM syndrome

Figure 2. Stages of CKM syndrome. The cardiovascular-kidney-metabolic (CKM) staging construct reflects the progressive pathophysiology and increasing absolute cardiovascular disease (CVD) risk along the spectrum of CKM syndrome. Stage 0 CKM includes individuals with normal weight, normal glucose, normal blood pressure, normal lipids, normal kidney function, and no evidence of subclinical or clinical CVD; the focus in stage 0 CKM is primordial prevention and preserving cardiovascular health. Stage 1 CKM includes individuals with excess adipose tissue, dysfunctional adipose tissue, or both. Excess adiposity is identified by either weight or abdominal obesity, and dysfunctional adipose tissue is reflected by impaired glucose tolerance and hyperglycemia. Stage 2 includes individuals with metabolic risk factors (hypertriglyceridemia, hypertension, metabolic syndrome, or type 2 diabetes), moderate- to high-risk chronic kidney disease (CKD), or both. Although hypertension and CKD are usually downstream of metabolic risk factors, the curved arrows represent individuals with nonmetabolic causes of these conditions; the risk implications and treatment approaches are similar. Stage 3 includes individuals with subclinical CVD with overlapping CKM risk factors (excess/dysfunctional adipose tissue, metabolic risk factors, or CKD) or those with the risk equivalents of very high-risk CKD or high predicted risk using the forthcoming CKM risk calculator. Stage 4 includes individuals with clinical CVD (coronary heart disease, HF, stroke, peripheral artery disease, or atrial fibrillation) overlapping with CKM risk factors. Afib indicates atrial fibrillation; ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; HF, heart failure; KDIGO, Kidney Disease Improving Global Outcomes; and PAD, peripheral artery disease (Figure and legend reprinted with permission from ref. 10).