Kidney Week

Abstract: SA-PO1171

Differential Risks of Mortality and Kidney Events by Cardiovascular-Kidney-Metabolic (CKM) Syndrome Stage: A Nationwide Japanese Cohort

Session Information

• CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Fujimoto, Kenta, Miyazaki Daigaku, Miyazaki, Miyazaki Prefecture, Japan

Kenta Fujimoto, MD, PhD

• Kikuchi, Masao, Miyazaki Daigaku, Miyazaki, Miyazaki Prefecture, Japan

Masao Kikuchi, DrMed

• Konta, Tsuneo, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Tsuneo Konta, MD, PhD

• Iseki, Kunitoshi, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Kunitoshi Iseki, MD, PhD

• Tsuruya, Kazuhiko, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Kazuhiko Tsuruya, MD, PhD

• Yamagata, Kunihiro, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Kunihiro Yamagata, MD, PhD

• Narita, Ichiei, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Ichiei Narita, MD, PhD

• Moriyama, Toshiki, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Toshiki Moriyama, MD, PhD

• Shibagaki, Yugo, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Yugo Shibagaki, MD

• Kasahara, Masato, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Masato Kasahara, MD, PhD

• Kondo, Masahide, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Masahide Kondo

• Asahi, Koichi, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Koichi Asahi, MD, PhD

• Watanabe, Tsuyoshi, Steering Committee of The Japan Specific Health Checkups (J-SHC) Study, Fukushima, Fukushima Prefecture, Japan

Tsuyoshi Watanabe, MD, PhD

• Kaikita, Koichi, Miyazaki Daigaku, Miyazaki, Miyazaki Prefecture, Japan

Koichi Kaikita, MD, PhD

• Fujimoto, Shouichi, Miyazaki Daigaku, Miyazaki, Miyazaki Prefecture, Japan

Shouichi Fujimoto, MD

Background

Cardiovascular-Kidney-Metabolic (CKM) syndrome, recently proposed by the American Heart Association, is an integrated disease construct encompassing cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic factors. It is classified into six stages based on the accumulation and severity of metabolic and organ dysfunctions. While CKM staging is linked to cardiovascular risk, its association with renal outcomes in Japanese remains unclear.

Methods

We analyzed 256,097 individuals from a Japanese health checkup database (median age 65 years, 42.1% male, 8.5% with CVD history, 8.9% with diabetes, 26.8% with CKD; median follow-up 1,544 days). Participants were classified into CKM stages 0 to 4b (Figure). CKM stage 3 included those with severe CKD, and stage 4b those with both CVD and CKD.
Outcomes included all-cause mortality, cardiovascular death, and composite renal outcome (doubling of serum creatinine, ≥40% decline in eGFR, or eGFR <15 mL/min/1.73 m²). Multivariable logistic regression estimated adjusted odds ratios (ORs) using stage 0 as reference. Covariates included age, sex, smoking, drinking, and exercise habits.

Results

There were 1,563 deaths (including 308 cardiovascular deaths) and 644 renal events. CKM stage 4b had the highest incidence of all-cause mortality (1.39%) and cardiovascular death (0.40%), with significant associations observed (all-cause mortality: OR 2.05, 95% CI 1.49–2.82; cardiovascular death: OR 2.74, 95% CI 1.41–5.31). Conversely, CKM stage 3 showed the highest risk for renal outcome (3.36%; OR 25.1, 95% CI 15.8–39.8) (Figure).

Conclusion

Our findings highlight distinct prognostic implications of CKM stages. While stage 4b predicted mortality outcomes, stage 3, reflecting severe CKD, conferred the greatest renal risk. These results underscore the importance of CKM staging in identifying patients at risk for specific outcomes and support tailored strategies to manage cardiovascular and renal risks separately.

Funding

• Government Support – Non-U.S.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025cdz61v5z