Kidney Week

Abstract: SA-PO0402

Lowering Mortality of Cardiovascular-Kidney-Metabolic Syndrome (CKM) by a Nonpharmacological Approach: Leveraging Resting Heart Rate to Maximize the Effect of Physical Activity

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Wen, Chi Pang, National Health Research Institutes, Zhunan Township, Taiwan

Chi Pang Wen, MD, DrPH

• Tsai, Min Kuang, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, New Taipei City, Taiwan

Min Kuang Tsai, PhD

• Wu, Mei-Yi, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, New Taipei City, Taiwan

Mei-Yi Wu, MD

• Wu, Mai-Szu, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, New Taipei City, Taiwan

Mai-Szu Wu, MD

Background

The concept of CKM syndrome was introduced by the American Heart Association to highlight the interconnected roles of chronic kidney disease, diabetes, and cardiovascular disease in driving mortality. Recent advances in GLP-1 receptor agonists and SGLT-2 inhibitors have transformed CKM management. In contrast, physical activity is a low-cost, widely accessible intervention with broad systemic benefits.

Methods

This study was based on a large-scale Taiwanese health screening cohort including 505,952 adults from 1994 to 2022, linked to the National Health Insurance Research Database for outcome ascertainment. CKM stages were defined according to AHA criteria. Participants were classified into five LTPA categories according to metabolic equivalent task (MET)-hours/week: inactive, low, medium, high, and very high. Estimated CRF was derived using a validated nonexercise prediction model incorporating age, body composition, PAI, and resting heart rate. Cox proportional hazards models were used to estimate hazard ratios for all-cause mortality.

Results

All-cause mortality risk increased progressively with advancing CKM stage. In CKM stage 4, participants with very high physical activity demonstrated substantially lower mortality risk compared with inactive individuals (HR 1.51, 95% CI 1.33–1.72 vs. HR 2.36, 95% CI 2.21–2.52). Higher PAI scores and greater estimated CRF were also associated with lower mortality risk across CKM stages. In stage 4 CKM, individuals with high estimated CRF had markedly lower mortality risk than those with low CRF (HR 1.77, 95% CI 1.52–2.07 vs. HR 2.34, 95% CI 2.10–2.60).

Conclusion

Monitoring and reducing RHR could not only provide immediate feedback to exercisers but could double or triple its benefits in mortality reduction from CKM, countering the “too little too late” perception. Physical activity, not GLP1 or SGLT2, as a first line treatment for CKM should be recommended by physicians.