The American journal of managed care
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In recent years, evidence has continued to mount showing a strong relationship between diabetes, cardiovascular disease, and chronic kidney disease. This, in turn, has driven a shift to a more integrated and holistic approach in the treatment of patients with cardio-renal-metabolic (CRM) disease. ⋯ The recommendations provide guidance on assessments and treatments, including both lifestyle therapy and pharmacotherapy, for patients across the DCRM spectrum, and are an invaluable tool for clinicians who need to develop treatment plans for complex patients with cardio-renal-metabolic disease. This article reviews the key elements of the DCRM recommendations and summarizes the updates included in the DCRM 2.0.
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Cardio-kidney-metabolic (CKM) syndrome is a term to describe the interconnection between cardiovascular disease, type 2 diabetes, and chronic kidney disease. The National Health and Nutrition Examination Survey from 1999 to 2020 estimated that 25% of participants had at least 1 CKM condition. It is proposed that CKM syndrome originates in excess and/or dysfunctional adipose tissue, which secretes proinflammatory and prooxidative products leading to damaged tissues in arteries, the heart, and the kidney, and reduction in insulin sensitivity. ⋯ The American Heart Association suggests that CKM syndrome screening should include both biological factors and SDOH. Interventions in patients with stages 0 to 3 CKM syndrome focus on preventing future cardiovascular events by management of excess adiposity, mainly through diet and exercise in the early stages, then through pharmacological treatment of metabolic syndrome components in later stages. There is a general acceptance that treatment of CKM syndrome should involve a holistic approach to prevention, screening, and management to improve outcomes and reduce long-term morbidity and mortality.