Kidney Week

Abstract: SA-PO0404

Cardiovascular-Kidney-Metabolic Syndrome Stages and the Full Spectrum of Cause-Specific Mortality: A Nationwide Korean Cohort Study

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

• Jung, Sehyun, Gyeongsang National University College of Medicine, Jinju-si, Gyeongsangnam-do, Korea (the Republic of)

Sehyun Jung, MD

• Han, Kyungdo, Soongsil University, Dongjak-gu, Seoul, Korea (the Republic of)

Kyungdo Han, PhD

• Koh, Jung Hun, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Jung Hun Koh, MD

• Kim, Minsang, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Minsang Kim, MD

• Lee, Jinsun, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Jinsun Lee, MD

• Ko, Ara, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Ara Ko, MD

• Oh, Jae-ik, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Jae-ik Oh, MD

• Kwon, Jin Kyung, Keimyung University School of Medicine, Daegu, Korea (the Republic of)

Jin Kyung Kwon, MD

• Kang, Min Woo, Korea University Guro Hospital, Guro-gu, Seoul, Korea (the Republic of)

Min Woo Kang, MD

• Kim, Seong Geun, Gangnam Severance Hospital, Seoul, Korea (the Republic of)

Seong Geun Kim, MD

• Cho, Semin, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Gyeonggi-do, Korea (the Republic of)

Semin Cho, MD

• Huh, Hyuk, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)

Hyuk Huh, MD

• Kim, Yaerim, Keimyung University School of Medicine, Daegu, Korea (the Republic of)

Yaerim Kim, MD, PhD

• Lee, Soojin, Eulji University Uijeongbu Eulji Medical Center, Uijeongbu-si, Gyeonggi-do, Korea (the Republic of)

Soojin Lee, MD, PhD

• Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Sehoon Park, MD, PhD

• Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Dong Ki Kim, MD, PhD

• Joo, Kwon Wook, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Kwon Wook Joo, MD, PhD

• Kang, Eunjeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Eunjeong Kang, MD, PhD

Background

The American Heart Association's cardiovascular–kidney–metabolic (CKM) syndrome framework integrates cardiometabolic risk factors and kidney disease into a unified staging system. Whether CKM staging captures excess mortality beyond cardiovascular causes remains poorly characterized.

Methods

Using the Korean National Health Insurance database, we analyzed 4,601,001 adults who underwent national health screening in 2012. CKM stages 0–4 were assigned using an AHA-based algorithm. Cause-specific mortality was ascertained through 2022 via the national death registry. Cox models estimated adjusted hazard ratios (aHRs) for 10 mortality categories, using stage 0 as the reference. Analyses were repeated after excluding participants with baseline eGFR <60 mL/min/1.73m².

Results

Over a mean follow-up of 10.2 years, advanced CKM stages were associated with graded increases in all-cause and cause-specific mortality. Cardiovascular mortality showed the steepest gradient (stage 3 aHR 2.59; stage 4 aHR 4.29). Substantial increases were also observed for renal/genitourinary disease (stage 3 aHR 7.95; stage 4 aHR 8.88), endocrine/metabolic disease (stage 3 aHR 12.98; stage 4 aHR 12.90), gastrointestinal disease (stage 4 aHR 3.49) and infection (stage 4 aHR 1.95). Among individuals with stage 4, the kidney failure subgroup (stage 4b) showed markedly higher mortality than stage 4a across cardiovascular (aHR 3.02), infectious (aHR 4.68), and renal/genitourinary causes (aHR 35.24). Results were consistent after excluding participants with reduced eGFR at baseline.

Conclusion

CKM stage was associated with a broad mortality risk spanning cardiovascular and non-cardiovascular causes. Within stage 4, kidney failure (stage 4b) substantially amplifies risk, underscoring the prognostic importance of advanced kidney dysfunction. CKM staging offers a comprehensive framework for multidisciplinary mortality risk stratification.