CKM syndrome screening key to addressing its growing challenges

Screening to facilitate early detection and interdisciplinary management is key to incorporating the cardiovascular-kidney-metabolic (CKM) health framework into Hong Kong’s healthcare system in order to address the growing challenges of CKM syndrome.

 

CKM syndrome – a new entity that emphasizes interconnections between atherosclerotic cardiovascular disease (ASCVD), atrial fibrillation (AF), heart failure (HF), chronic kidney disease (CKD), excess adiposity, metabolic syndrome, and diabetes – is categorized into five progressive stages. [Circulation 2023;148:1606-1635]

 

“The CKM health framework prioritizes identifying and treating CKM risk factors during the preclinical phase to prevent clinical ASCVD, AF, HF, and kidney failure,” wrote authors of a recently published position statement from the Hong Kong College of Physicians (HKCP). [Hong Kong Med J 2025;doi:10.12809/hkmj2412200]

 

Primary care doctors play a central role in identifying patients with early stages of CKM syndrome, which are often asymptomatic, and in ensuring regular follow-up, the authors emphasized.

 

Metabolic screening

“Screening asymptomatic individuals for metabolic risk factors is a key component of the CKM health framework. For adults aged ≥21 years, BMI and waist circumference should be measured annually, along with periodic assessments of blood pressure, lipid levels, and glycaemic status,” the authors wrote. “Screening interval is every 3–5 years for CKM stage 0 [healthy and lean], every 2–3 years for CKM stage 1 [overweight/obese or prediabetes], and annually for CKM stage 2 [diabetes, hypertension, or hypertriglyceridaemia].”

 

The “family doctor for all” vision and Chronic Disease Co-Care Pilot Scheme are strengths in Hong Kong's current healthcare system supportive of implementation of the above, they noted. “The need for triglyceride screening remains unclear, and discussions continue regarding BMI thresholds for overweight/obesity in Asian populations,” they added.

 

Kidney screening

“Kidney health is central to CKM syndrome, given the high prevalence of kidney failure among patients with diabetes or CVD,” the authors pointed out.

 

The CKM framework recommends CKD screening before the age of 21 years for individuals with risk factors such as obesity, hypertriglyceridaemia, diabetes, or hypertension. While regular screening for kidney complications is available for patients with hypertension or diabetes in Hong Kong’s public sector, the authors noted gaps in albuminuria screening in other high-risk groups, including overweight/obese individuals and those with clinical CVD.

 

CV screening

In addition to CKD screening as part of CV risk assessment, the CKM framework recommends coronary artery calcium (CAC) testing to further stratify CVD risk and guide statin use for primary prevention, while testing for B-type natriuretic peptide (BNP), N-terminal pro-BNP or high-sensitivity troponin is proposed to detect subclinical HF.

 

In Hong Kong, although regular screening for CV complications and risk factors is available for patients with hypertension or diabetes, routine CAC or cardiac biomarker testing is not recommended for asymptomatic individuals.

 

For asymptomatic individuals without ASCVD or HF, use of the American Heart Association’s online Predicting Risk of CVD Events (PREVENT) equation is recommended to assess 10-year CVD risk.

 

Interdisciplinary management

“The HKCP emphasizes the need for collaborative interdisciplinary care within the CKM health framework, integrating primary care, specialist care and medical subspecialities to prevent complications and protect organs,” the authors wrote.

 

While angiotensin-converting enzyme inhibitors are already recommended as first-line medications in Hong Kong, particularly for patients with diabetes, access to newer CKM pharmacotherapies is limited.

 

“Discrepancies in drug formularies between primary care and specialty clinics in the public sector sometimes led to referrals to specialty clinics solely for medications unavailable in primary care. Such referrals may lead to increased waiting time at overburdened specialty clinics, delayed initiation of guideline-directed medical therapy, and extended follow-up intervals,” the authors pointed out.