Cardiovascular-kidney-metabolic syndrome in Indonesia: a commentary on the need for integrated management and policy action.

Cardiovascular-kidney-metabolic (CKM) syndrome is a term introduced to reflect the multidirectional relationship between metabolic disorders, kidney disease, and cardiovascular disease (CVD). The prevalence of CKM syndrome, accompanied by its increasing morbidity and mortality, has led researchers, clinicians, and policymakers to undertake synergistic and collaborative efforts in various countries. CKM Syndrome can be categorized into four stages: stage 0 (no risk factors), stage 1 (excessive or dysfunctional adiposity), stage 2 (metabolic risk factors or moderate to high-risk chronic kidney disease/CKD), stage 3 (subclinical cardiovascular disease or CKM syndrome risk equivalents), and stage 4 (clinical CVD in CKM). As the late stage in CKM syndrome, CVD become the leading cause of mortality in Indonesia, accounting for 37-38% of all deaths, with stroke and ischemic heart disease being the predominant causes. Over time, Indonesia has also seen an increase in the prevalence of other illnesses that contribute to the development of CKM syndrome, such as obesity, diabetes mellitus, CKD, hypertension, and dyslipidemia. Rapid urbanization, lifestyle changes, and demographic transitions have amplified the risk of CKM-related conditions. This perspective highlights the emerging risk factors for CKM syndrome in Indonesia, including diabetes mellitus and metabolic syndrome, CKD, and hypertension. This study relies on secondary data from national surveys, government policy reports, and scientific studies related to CKM syndrome. Data were selected based on relevance to CVD, kidney disease, as well as metabolic disorders. Furthermore, we discuss how these factors put a disproportionate burden on the Indonesian health system and should be looked up as a unified clinical as well as public health challenges, rather than separate entities. Addressing CKM syndrome in Indonesia requires early detection in primary care, integration and collaboration programs, as well as multi-sectoral approaches to reduce the progression of CKM syndrome. The lessons from Indonesia may provide insight for other low middle-income countries (LMICs) undergoing similar conditions.