CKM Screening Can't Wait

CKM Screening Can’t Wait: Using Biomarkers to Detect Progression

In the second video of this series, PA Viet Le explores the pathophysiology behind CKM syndrome, highlighting the bidirectional relationship between the heart and kidneys and the four core mechanisms driving disease progression: inflammation and oxidative stress, insulin resistance, dysfunctional adipose tissue, and neurohormonal activation. He explains why key biomarkers like eGFR, UACR, and NT-proBNP are essential tools for catching subclinical organ involvement before symptoms appear.

PA Le also walks through how to incorporate these markers into everyday practice, including using the AHA PREVENT calculator to personalize cardiovascular risk assessment.

Key Takeaways:

eGFR and UACR can detect kidney disease before it is symptomatic.
UACR is an independent predictor of cardiovascular risk and should be used at least annually for patients in CKM stage 2 and higher.
NT proBNP is highly prognostic for heart failure risk.

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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

Chang DR, Yeh HC, Ting IW, et al. The ratio and difference of urine protein-to-creatinine ratio and albumin-to-creatinine ratio facilitate risk prediction of all-cause mortality. Sci Rep. 2021;11:7851. https://pubmed.ncbi.nlm.nih.gov/33846379/

Claudel SE, Verma A. Albuminuria in cardiovascular, kidney, and metabolic disorders: a state-of-the-art review. Circulation. 2025;151(10). https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.071079

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-1305. https://pubmed.ncbi.nlm.nih.gov/15385656/

Gunnarsson S, Vito O, Unwin RJ. Cardiovascular-kidney-metabolic syndrome: prevalence, risks, disease tradjectories, and early-stage management. Am J Physiol-Cell Physiol. 2026;330(1). https://pubmed.ncbi.nlm.nih.gov/41269265/

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

Khan SS, Bhave N, Blumenthal RS, et al. Use of Predicted Risk and Expected Benefit to Guide Decision-Making in Cardiovascular-Kidney-Metabolic Syndrome for the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology, Circulation. Circulation. Published online June 9, 2026. doi:10.1161/CIR.0000000000001447. https://pubmed.ncbi.nlm.nih.gov/42263147/

Khan SS, Coresh J, Pencina MJ, et al. Novel prediction equations for absolute risk assessment of total cardiovascular disease incorporating cardiovascular-kidney-metabolic health: a scientific statement from the American Heart Association. Circulation. 2023;148:1982-2004. https://pubmed.ncbi.nlm.nih.gov/37947094/

Marassi M, Fadini GP. The cardio-renal-metabolic connection: a review of the evidence. Cardiovasc Diabetol. 2023;22:195. https://pubmed.ncbi.nlm.nih.gov/37525273/

Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148:1636-1664. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001186

Ndumele CE, Rangaswami J, Chow SL, et al. Cardiovascular-kidney-metabolic health: a presidential advisory from the American Heart Association. Circulation. 2023;148:1606-1635. https://www.ahajournals.org/doi/10.1161/cir.0000000000001184

Nzobokela J, Muchaili L, Mwambungu A, Masenga SK, Kirabo A. Pathophysiology and emerging biomarkers of cardiovascular-renal-hepato-metabolic syndrome. Front Cardiovasc Med. 2025;12. https://pubmed.ncbi.nlm.nih.gov/41235339/

Pop-Busui R, Repetto E, Baron J, Schumacher D, Vaduganathan M, Pandey A. Screening natriuretic peptide levels predicts heart failure and death in individuals with type 1 and type 2 diabetes without known heart failure. Diabetes Care. 2025;48(12):2145-2153. https://diabetesjournals.org/care/article/48/12/2145/163727/Screening-Natriuretic-Peptide-Levels-Predicts

Tain YL, Hsu CN. The renin–angiotensin system and cardiovascular–kidney–metabolic syndrome: focus on early-life programming. Int J Mol Sci. 2024;25:3298. https://pubmed.ncbi.nlm.nih.gov/38542273/

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.