The Four-Stage CKM Staging System (0–4) Staging youths and adults to prevent progression and tailor therapy to risk

Authors

  • Dr. Pallavi Mishra, MBBS, MD (Medicine), KGMU M.Sc Cardiology, South Wales Diabeteto -Cardiologist Women cardiologist Echocardiography Specialist Supreme Director, Panacea Hospital & Diabetes Care Organisation, Varanasi Englsh Author

Keywords:

CKM syndrome, staging system, cardiovascular disease, chronic kidney disease, obesity, prediabetes, metabolic risk factors, PREVENT equations, risk stratification, youth prevention, lifestyle intervention, regression

Abstract

Abstract

The 2026 cardiovascular–kidney–metabolic (CKM) guideline formalizes a four-stage staging system designed to support earlier prevention and individualized treatment in both youths and adults. Stage 0 represents absence of CKM risk factors, Stage 1 includes overweight or obesity and/or prediabetes without other metabolic, kidney, or cardiovascular disease, Stage 2 includes one or more metabolic risk factors or established kidney disease without clinical cardiovascular disease, Stage 3 captures asymptomatic cardiovascular disease or very-high-risk CKD or elevated predicted cardiovascular risk, and Stage 4 includes established cardiovascular disease with concurrent CKM risk factors. The staging framework is intended to prevent progression, reduce cardiovascular and kidney complications, and encourage regression through lifestyle intervention and weight loss. By linking treatment decisions to absolute risk and disease stage, the system provides a practical clinical tool for prevention, therapy selection, and population management.

     
The Four-Stage CKM Staging System (0–4) Staging youths and adults to prevent progression and tailor therapy to risk Figure 2. The Four-Stage CKM Staging System (0–4) — mechanism overview (illustrative; labels added for education). At the heart of the 2026 guideline is a practical staging system that spans Stage 0 through Stage 4. CKM staging is recommended for both youths and adults, with explicit goals: prevent stage progression, tailor therapy to absolute risk, reduce cardiovascular events and kidney-function loss, and—importantly—promote regression through lifestyle change and weight loss.2 <b>Stage 0</b> denotes no CKM risk factors and is the target of primordial prevention. <b>Stage 1</b> is overweight/obesity or prediabetes without other metabolic risk factors, kidney disease, or cardiovascular disease.1 This is the earliest actionable window, where lifestyle intervention can reverse trajectory. <b>Stage 2</b> captures one or more metabolic risk factors—high blood pressure, abnormal lipids, type 2 diabetes, or metabolic syndrome—and/or established kidney disease, but still without clinical cardiovascular disease.1 This is where guideline-directed medical therapy with organ-protective agents typically begins. <b>Stage 3</b> represents subclinical (asymptomatic) cardiovascular disease with CKM risk factors, or risk equivalents such as very-high-risk CKD or a high predicted 10-year cardiovascular risk based on the PREVENT equations.1 <b>Stage 4</b> is diagnosed cardiovascular disease—coronary heart disease, heart failure, stroke, peripheral artery disease, and/or atrial fibrillation—occurring alongside overweight/obesity, other metabolic risk factors, or kidney disease.1 Two features make the system especially useful in practice. First, staging is explicitly recommended for youths as well as adults, pushing prevention earlier into the life course than most cardiometabolic frameworks.2 Second, the guideline frames the goal not only as halting progression but as actively promoting regression through lifestyle change and weight loss—so a patient can move from Stage 1 back toward Stage 0.2 That bidirectional logic gives clinicians and patients a shared, motivating vocabulary for early action. The staging builds directly on the four-stage progression first outlined in the 2023 AHA presidential advisory that introduced the syndrome, now formalised into an actionable clinical tool.3 For hospital systems, staging offers a simple way to segment populations, allocate multidisciplinary resources, and set measurable quality targets—for example, tracking the proportion of Stage 2 patients on appropriate SGLT2 inhibitor or RAS-inhibitor therapy. Because the system rewards regression as well as prevention of progression, it aligns clinical incentives with the earliest, most cost-effective interventions. References 1. First-ever guideline on CKM syndrome issued, AHA Newsroom, June 9, 2026. https://newsroom.heart.org/news/first-ever-guideline-on-cardiovascular-kidney-metabolic-syndrome-issued 2. 2026 CKM Guideline — Top Things to Know, professional.heart.org, June 9, 2026. https://professional.heart.org/en/science-news/2026-guideline-for-the-prevention-detection-evaluation-and-management-of-ckm-syndrome/top-things-to-know 3. A new guideline links care for heart, kidney and metabolic diseases, Science News, June 10, 2026. https://www.sciencenews.org/article/heart-diabetes-kidney-disease-treatment 4. First-Ever Guideline Addresses CKM Syndrome, ACC.org Journal Scan, June 9, 2026. https://www.acc.org/latest-in-cardiology/journal-scans/2026/06/08/17/44/first-ever-guideline-addresses-ckm-syndrome 5. New guideline reframes weight as health risk, AHA Newsroom, June 9, 2026. https://newsroom.heart.org/news/new-guideline-reframes-weight-as-health-risk-tied-to-diabetes-kidney-and-heart-conditions 6. The Role of GLP-1 Receptor Agonists in the Treatment of CKM Syndrome, JACC Adv, Jan 2026 (PMID 41609289). https://pubmed.ncbi.nlm.nih.gov/41609289/

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Published

2026-07-07

Issue

Vol. 4 No. 2 (2026): The Four-Stage CKM Staging System (0–4) Staging youths and adults to prevent progression and tailor therapy to risk

Section

Articles

How to Cite

The Four-Stage CKM Staging System (0–4) Staging youths and adults to prevent progression and tailor therapy to risk. (2026). Diabzen, 4(2), 4-5. https://thediabzen.com/index.php/d/article/view/41

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