by Grace L. Chua MD, FRCPC, FACC, Cardiologist
Chronic kidney disease (CKD) affects one in 10, or approximately four million Canadians. Diabetes is the largest contributor to end stage kidney disease (ESKD). It is estimated that CKD affects two in five patients with type 2 diabetes. People with diabetes are also twice as likely to develop heart disease. It is well known that there is a strong correlation between heart and kidney disease. With time, diabetes causes damage to blood vessels. In the kidneys, this leads to an increase of leakage of protein in the urine as the vessels are damaged. Damage of blood vessels also occurs in the heart. As more protein leaks into the urine and kidney function worsens, the risk of a cardiovascular event increases proportionally. CKD also affects certain hormones in the body that increase blood pressure, fluid retention and promote congestive heart failure (CHF).
Cardiovascular-kidney-metabolic syndrome
What is the link that binds diabetes, kidney and heart disease together, and why are so many Canadians affected by all three conditions? In 2023, the American Heart Association formally defined the cardiovascular-kidney-metabolic (CKM) syndrome.(1) There are four stages in the CKM syndrome:
Stage 0: No risk factors or disease.
Stage 1: An excess of dysfunctional adipose (fat) tissue.
Stage 2: Development of risk factors such as high blood pressure, type 2 diabetes, metabolic syndrome and high triglycerides.
Stage 3: Heart and blood vessel problems (including CKD) begin, but individuals do not have symptoms and may not realize that they have these conditions. Early detection of these conditions can occur via regular check-ups with a healthcare provider.
Stage 4: Signs and symptoms of heart disease, plus/minus advanced CKD occur. Heart disease signs and symptoms include chest pain, shortness of breath, palpitations, fatigue, lightheadedness, swelling of the feet and ankles, and a decrease in how much activity you can do. Change in vision, speech, weakness and numbness, particularly if localized to one side, could be a sign of stroke. For kidney disease, there could be a change in urination pattern, nausea, difficulty concentrating, dry and itchy skin, muscle cramps, fatigue, weakness, loss of appetite and swelling of the ankles. Signs and symptoms can overlap if there is presence of more than one condition.
What is dysfunctional adipose tissue?
We all have fat stores under our skin in certain areas of our body that are used for a rainy day when burning fat is required for energy. Lack of physical activity, an increased intake of highly processed foods and sugar, as well as stress, lack of sleep, smoking and sometimes genetic predisposition, leads to enlargement of fat cells. This leads to an increase in secretion of inflammatory substances that are not present in normal fat cells. An excess accumulation of dysfunctional adipose tissue leads to obesity. Dysfunctional adipose tissue accumulates around the belly (visceral fat) as well as organs such as the liver, pancreas, kidney and heart. Inflammation in these organs leads to diseases such as fatty liver, insulin resistance, diabetes, CKD, heart attacks, strokes, irregular heart rhythm (atrial fibrillation) and heart failure.
What can be done?
The good news is that whether you have diabetes or not, you can prevent CKM syndrome, diabetes, and other cardiac risk factors by preventing accumulation of inflammatory fat in the wrong places or dysfunctional adipose tissue. Dysfunctional adipose tissue is the root cause of CKM syndrome.
Prevention includes “Life’s Essential 8” as defined by the American Heart Association:
- Eat Better—include lots of fruit, vegetables, whole grains, lean protein, nuts and seeds. Eat low fat and unsaturated fats, avoid sugars and highly processed foods. Control portion sizes and limit alcohol intake as much as possible to special occasions only.
- Be More Active —150 minutes of moderate cardiovascular exercise such as walking, biking, swimming, as well as resistance training 2 to 3 times per week.
- Stop smoking—including tobacco products and vaping.
- Get enough healthy sleep —aim for an average of 7 to 9 hours for adults.
- Manage Weight —maintain an optimal body mass index (BMI) and waist circumference. Consult a healthcare professional or calculate your healthy BMI and waist circumference. Avoid weight gain or accumulation of inflammatory fat in the wrong places (i.e., around the waist).
- Control Cholesterol elevated levels of non-HDL or bad cholesterol can cause heart disease. Consult a healthcare professional to determine the optimal value for you.
- Manage blood sugar—monitor your hemoglobin A1c with your healthcare provider as an abnormal hemoglobin A1c can signal prediabetes and for people with diabetes, it measures the level of control in the past 2-3 months.
- Manage blood pressure (BP)—In adults with diabetes, a BP of less than 130/80 mm Hg is optimal to prevent heart and kidney disease.
The key is to start early by preventing cardiac risk factors, including diabetes and obesity. However, it is never too late to start Life’s Essential 8, even if you already have risk factors, CKM syndrome or heart disease. Also, there are now many effective medications that have been proven to protect your heart and kidneys or can prevent worsening of heart and kidney disease by decreasing inflammation. Some even help to control your blood sugar and help you lose weight. Ask your healthcare provider for more information regarding these medications and whether they are right for you.
This content is supported by Bayer Inc. The author maintains editorial control over this content. Statements of fact and opinions expressed are those of the author and do not necessarily reflect the views or position of Bayer Inc.
