CKM Progression in the Absence of Intervention

In the fourth and final video of this series, PA Viet Le returns to patient Maria two years after her stage 1 CKM diagnosis to show what happens when obesity and its related risk factors go unaddressed. Now presenting with new hypertension and hypertriglyceridemia, Maria has progressed to stage 2 CKM, and her 10-year and 30-year cardiovascular risk scores have both climbed significantly.

PA Le walks through the treatment decisions this progression demands, including guideline-directed therapies for kidney and cardiovascular risk reduction, and reinforces the importance of shared decision-making in improving adherence and outcomes. This case-based conclusion underscores the urgency of early, decisive action to prevent CKM from advancing further.

Key Takeaways:

Obesity is a major driver of CKM; without treatment, CKM is likely to progress.
Stage 2 CKM is a time for swift, decisive treatment recommendations to reduce the risk of disease progression.
Shared decision making is important for the success of treatment.

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Speaker

Click on the photo below to learn more about the speaker.

Viet Le, DMSc, MPAS, PA-C, FACC, FAHA, HF-Cert

References and Additional Resources:

American Heart Association. PREVENT^TMOnline Calculator. Accessed July 2, 2026. https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

Deniz S, Akbolat M, Çimen M, Ünal O. The mediating role of shared decision-making in the effect of the patient-physician relationship on compliance with treatment. J Patient Exp. 2021; May 20;8:23743735211018066. doi: 10.1177/23743735211018066. https://pubmed.ncbi.nlm.nih.gov/34179444/

Gupta DK, Daniels LB, Cheng S, et al. Differences in natriuretic peptide levels by race/ethnicity (from the multi-ethnic study of atherosclerosis). Am J Cardiol. 2017;120(6):1008-1015. https://pmc.ncbi.nlm.nih.gov/articles/PMC5575954/

KDIGO. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Accessed July 2, 2026. https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf

Kozhuharov N, Martin J, Wussler D, et al. Clinical effect of obesity on N-terminal pro-B-type natriuretic peptide cut-off concentrations for the diagnosis of acute heart failure. Eur J Heart Fail. 2022;24(9):1545-1554. https://pmc.ncbi.nlm.nih.gov/articles/PMC9804229/

Wadden TA, Chao AM, Moore M, et al. The role of lifestyle modification with second-generation anti-obesity medications: comparisons, questions, and clinical opportunities. Curr Obes Rep. 2023;12(4):453-473. https://pubmed.ncbi.nlm.nih.gov/38041774/

Wanner C, Zhao M-H, Amin AN, et al. Guideline-recommended disease-modifying therapies for patients with cardiorenal disease: a call-to-action narrative review. Adv Ther. 2025;42(7):3141-3157. https://pmc.ncbi.nlm.nih.gov/articles/PMC12182529/

Supported by

Viet Le, DMSc, MPAS, PA-C, FACC, FAHA, HF-Cert

Viet is an Associate Professor of Research and Preventive Cardiology PA at Intermountain Medical Center and co-directs the Preventive Cardiology Clinic. He has a bachelor’s in exercise science/athletic training, trained as a physician assistant at the University of Utah School of Medicine, and obtained his doctorate in Health Professions Education. He is Principal/Sub-Investigator on clinical trials and has authored/co-authored over 80 abstracts and 50 publications. He is past president of the Academy of PAs in Cardiology, past co-chair of the American College of Cardiology PA Work Group, and serves as the President of the Utah Academy of PAs.