Podcast Summary: The Link Between the Heart and the Kidneys: Cardiovascular Kidney Metabolic Syndrome

Podcast: Taking Control Of Your Diabetes® - The Podcast!
Hosts: Dr. Steve Edelman (B), Dr. Jeremy Pettus (A)
Guest: Dr. Jennifer Green (C), Endocrinologist, Duke University
Release Date: February 10, 2025

Episode Overview

In this episode, Dr. Jeremy Pettus and Dr. Steve Edelman take a deep dive into the interconnectedness of the heart and kidneys, especially as it relates to diabetes, through the lens of the increasingly recognized Cardiorenal Metabolic Syndrome (CKM or CRM). They are joined by Dr. Jennifer Green, a leading endocrinologist and researcher, for an accessible and informative discussion aimed at people living with diabetes. The episode addresses what CKM syndrome is, why these body systems are so deeply connected, how clinicians are shifting from a “siloed” approach, and how modern diabetes medications are offering new hope for prevention and holistic care.

Key Discussion Points & Insights

1. The Heart-Kidney Relationship and CKM Syndrome

• Interdependency Explained

  • The heart and kidneys are described as a “married couple”—intimately affecting each other, especially in diabetes.
    • Quote [00:20], Pettus:
      “Your heart and your kidneys are like a married couple. What one does always affects the other. In sickness and in health. To death do them part.”
  • The term “cardiorenal metabolic syndrome” encapsulates the connection between heart (cardio), kidney (renal), and metabolic conditions (often diabetes).

• Bringing Patients into the Discussion

  • Despite being discussed among specialists, patients with diabetes rarely hear about the syndrome directly.
    • Quote [01:50], Edelman:
      “It’s a topic that's discussed with healthcare professionals...but it hardly ever gets discussed right directly to people living with diabetes. So we felt this is important.”

2. Dr. Jennifer Green’s Role and Definition of CKM

• Dr. Green splits her time between clinical research and caring for mostly older patients, many of whom have longstanding diabetes and organ complications.

• Defining CKM:

  • Not a strict medical definition; rather, a recognition that heart, kidney, and “metabolic” (diabetes, prediabetes, obesity, liver disease) issues overlap significantly.
    • Quote [06:46], Green:
      “These are linked together probably because they have several common pathophysiologic pathways or... risk factors that tend to result in a variety of different complications... These complications can occur along a similar timeframe, particularly in the life of people with diabetes.”

• Key Message:

  • This isn’t all doom and gloom: “I think of this as an opportunity and really an exciting time rather than just talking about all the bad things that can happen.” [07:44, Green]

3. Why Siloed Care is a Problem

• Current State: Many providers manage diabetes, cardiovascular disease, and kidney disease independently (“in silos”), leading to missed opportunities for holistic care.
  • Quote [08:20], Edelman:
    “I think these conditions are treated in silos, and I think that's one of the problems.”

4. What Comes First? Sequence of CKM Complications

• The relationship can be bidirectional—some patients develop heart or kidney issues first; others are diagnosed with long-term diabetes before these complications appear.
  • Quote [09:38], Green: “What comes first is not particularly well understood... the sequence with which these things can occur is highly variable.”
• Early detection and intervention make a “very, very significant difference.”

5. Shared Responsibility and the Problem with Handoffs

• “Hot Potato” of Risk Reduction: Providers sometimes avoid addressing issues if they think another specialist is responsible; things fall through the cracks.

  • Quote [12:28], Green:
    “Risk reduction is not a hot potato that we can just toss to the next doctor... It’s a shared responsibility.”

• Communication, even with electronic medical records, is still a challenge:

  • Quote [14:05], Green:
    “I almost think it’s worse because the notes are filled with so much, I hate to say irrelevant information, but it’s hard to get to what is really important.”

6. Screening & Prevention: What Should Patients Know?

• Kidney Disease:

  • Screening is crucial but often incomplete. Both a blood test for creatinine and a urine test for albumin must be done yearly.
    • Quote [15:34], Green:
      “Doctors... do a pretty good job at measuring creatinine... but what is forgotten about half the time is to get the urine sample... We forget to do that.”

• Empowering Patients:

  • Patients should know to ask for the right tests annually—both blood and urine.
  • “Every year I need to get a blood and a urine test and my doctor should know what that is to be kind of preventative.” [18:35, Pettus]

• ABCDs of Diabetes Care (A1C, Blood pressure, Cholesterol, Diabetes drugs):

  • Dr. Green admits she mentally runs through this list for every patient, but may not always communicate each piece to patients explicitly.
    • Quote [19:42], Green:
      “I’m running a mental checklist... but I probably don’t communicate that I’m thinking about all of that to the person.”

7. Advances in Medication: A New Era

• Game-Changing Drugs:

  • SGLT2 inhibitors (e.g., Jardiance, Farxiga) and GLP-1 receptor agonists (e.g., Ozempic, Mounjaro) are now proven to help not only blood sugar, but also heart, kidney, and even liver health.
    • Quote [24:39], Green:
      “These drugs... ended up being actually very, very good for the cardiovascular system and the kidneys and probably a whole host of other things... It’s a very exciting time... to treat people with what I consider to be great efficiency.”

• Cross-specialty Collaboration:

  • The rise of these medications is causing more collaboration among endocrinologists, cardiologists, and nephrologists.
    • Quote [26:16], Edelman:
      “It put together more communication between these subspecialists. And I think... that is sort of when this cardiorenal metabolic syndrome really took off in terms of... being a hot topic.”

8. Long-term Medication Use—Myths and Realities

• Many patients are tempted to stop medications like GLP-1s after short-term benefits (e.g., weight loss).

  • Quote [28:42], Green:
    “Our bodies probably have, our brains probably have a weight set point... when we stop the medicine, our brain kind of wakes up and says, oh yeah, you’re supposed to weigh 220 pounds, let’s get back up there.”

• These medications have benefits beyond weight loss; stopping them can lead to a loss of heart, kidney, and other “protection.”

  • Quote [33:14], Edelman:
    “Not all the benefits we see with these drugs are due directly to weight loss... so you can’t, when you gain the weight back, you know that's not good, but you’re losing the benefit that you’d have on the heart, the kidneys, the joints in your knee, the liver.”

9. Access & Advocacy for People with Type 1 Diabetes

• Most of the research and benefits so far have focused on type 2 diabetes. Access for type 1s is lagging, but studies are ongoing.
  • Quote [34:43], Green:
    “That’s a group of people who really have largely not benefited from all this tremendous amount of information... but there should be more [data] in the relatively near future.”

10. Patient Empowerment and Final Takeaways

• Key patient takeaways:

  • Know about CKM syndrome and discuss all its components with your medical team.
  • Come prepared with questions: How’s my heart health? Kidney health? Liver health? Are my ABCDs being addressed at each visit?
    • Quote [21:59], Green:
      “Ask about those things, go down that ABCD checklist... it's up to the person who's there for the appointment to bring up some of these topics.”

• Positive Outlook:

  • Don’t be fatalistic about complications; there are real, actionable steps and treatments that make a difference.
    • Quote [36:05], Green:
      “This is not a doom and gloom or a depressing type subject matter. I think it’s an exciting time... we have the opportunity to intervene meaningfully in people’s lives and keep them healthy for the long term.”

• Closing Words:

  • Take control, be proactive, and see your diabetes specialist as the “center spoke” coordinating your care.

Notable Quotes & Memorable Moments

• On Siloed Care:
  “Risk reduction is not a hot potato that we can just toss to the next doctor... It’s a shared responsibility.”
  — Dr. Jennifer Green [12:28]
• On Screening for Kidney Disease:
  “We forget to do that. That’s... equally as important in looking for kidney disease as doing the blood test.”
  — Dr. Jennifer Green [15:34]
• On Medication Advancements:
  “It’s a very exciting time... to treat people with what I consider to be great efficiency.”
  — Dr. Jennifer Green [24:39]
• On Patient Empowerment:
  “They may need to serve as their own advocates and feel free to ask questions about these kinds of complications in order to really get the treatment that they need and deserve.”
  — Dr. Jennifer Green [36:05]
• Humorous Moment:
  “This is the time that Jeremy starts crying.”
  — Dr. Steve Edelman [34:42]

Timestamps for Key Segments

• [00:20] – Introduction & analogy of heart/kidney as “married couple”
• [02:48] – Introduction of Dr. Jennifer Green
• [04:34] – Dr. Green describes CKM, her work, and patient population
• [06:46] – Defining CKM and how it’s opportunistic (not doom and gloom)
• [09:38] – Sequence of how these conditions develop
• [12:28] – The “hot potato” problem in risk management
• [15:34] – Importance of kidney disease screening and simple patient advocacy
• [18:35] – ABCD approach discussed; patient need to ask about targets
• [24:39] – Medication revolution and cross-specialty impact
• [28:42] – Long-term benefit of new medications and why stopping them can be a problem
• [34:43] – Access for Type 1 diabetes and ongoing research
• [36:05] – Final words, focusing on action and empowerment

Final Takeaways

• CKM syndrome is a pivotal concept connecting heart, kidney, and metabolic (diabetes-related) health.
• Modern diabetes medications now target all three organ systems—an unprecedented advancement.
• Advocating for yourself and knowing what questions to ask at every visit makes a difference.
• Don’t let the risks intimidate you—knowledge and proactive care can help you thrive with diabetes.