Being overweight, having high blood pressure, or having elevated blood sugar levels increases your health risks. However, maintaining a healthy weight and normal blood pressure and blood sugar levels does not guarantee immunity from health risks.
Harmful fats hidden within the body, whether adhering to blood vessels or accumulating in the abdominal cavity and liver, increase health risks. Yet, standard metrics such as Body Mass Index (BMI), blood pressure, and blood sugar levels do not always reveal the full picture.
For some individuals, basic screenings are simply not enough.
As a silent threat, metabolic dysfunction can compromise the interconnected cardiovascular and kidney systems long before a clinical problem is detected.
BNH Hospital understands the interplay between these bodily systems. We have integrated care for all three areas into a single department to provide comprehensive, holistic treatment. Our focus on prevention allows us to detect early warning signs across all three systems, even before symptoms appear, enabling continuous treatment and long-term health monitoring.
If you are unsure about potential warning signs in your body, schedule an in-depth health risk assessment at Cardiovascular Kidney Metabolic Centre (CKM) at 4th Floor and receive guidance on sustainably reducing your health risks.
Interested in consulting a doctor to assess your cardio-kidney-metabolic risks?
Table of Contents
Good results come from taking care of cardiovascular, kidney, and metabolic health at the same time
The interconnected cardiovascular, kidney, and metabolic systems are collectively referred to as CKM.
C stands for Cardiovascular, which refers to the cardiovascular system.
- Risks to the cardiovascular system
When blood sugar, blood lipid, or blood pressure levels remain high, blood vessel walls may deteriorate and become narrowed, causing the heart to work harder and increasing the risk of ischaemic heart disease, heart failure, and arrhythmias.
- Our approach to care
We assess risk by identifying abnormalities in blood vessel structure and heart rhythm, and diagnose and treat diseases of the cardiovascular system, such as coronary artery disease, arrhythmias, and heart failure.
K stands for Kidney, which refers to the kidney system.
The kidneys play an important role in regulating blood pressure, fluid balance, electrolytes and waste excretion.
- Risks to the kidney system
Poorly controlled high blood pressure and diabetes can damage the small blood vessels in the kidneys, reducing their filtering efficiency. Fluid and waste can then build up, potentially leading to chronic kidney disease and increasing the workload of the heart.
- Our approach to care
We monitor kidney function by evaluating glomerular filtration, protein leakage, fluid and electrolyte balance, and blood pressure. We also manage risk factors, help slow the decline in kidney function and plan treatment according to the stage of the disease.
M stands for Metabolic, which refers to the endocrine and metabolic system.
The endocrine and metabolic system works to control metabolism and the absorption of nutrients. It affects weight, blood sugar levels, blood lipid levels, blood pressure, and hormone levels.
- Metabolic risks
Metabolic risks include insulin resistance, diabetes, abnormal lipid levels, obesity, fatty liver, and hormonal disorders such as hyperthyroidism.
- Our approach to care
We manage diabetes, blood fats, weight, thyroid, and hormones, and reduce risk factors that may affect the heart, kidneys, and blood vessels in the long term, including through sustainable weight control.
The cardiovascular, kidney, and metabolic systems work continuously. Problems starting in one system can increase the health risks of the other two systems in a cyclical manner.
Once issues arise within the cardiovascular, kidney, or metabolic systems, whether due to lifestyle factors or genetics and regardless of which system is affected first, they trigger a cycle that impacts the other systems. This leads to a cluster of interrelated disorders across these three major bodily systems, known as CKM Syndrome. Without appropriate intervention, these interconnected conditions may progressively worsen.
Therefore, managing all three systems simultaneously helps reduce risk in one area while promoting health in the others. BNH Cardiovascular Kidney Metabolic Centre prioritises patients’ long-term health. Consequently, specialists collaborate to provide comprehensive care that addresses all three systems concurrently.
"Sick Fat" The Root Cause of Chronic Diseases, Even in Thin People
“Sick fat” refers to adipose tissue that is dysfunctional and detrimental to the body. It primarily encompasses visceral fat and fatty liver, resulting from excessive fat accumulation that causes fat cells to malfunction and secrete increased levels of inflammatory substances. This elevates the risk of insulin resistance, diabetes, hypertension, and heart disease.
Most people gauge their health, even before symptoms appear, based on weight, blood pressure, blood lipid levels, and blood sugar levels. However, “sick fat” can exist even in individuals with normal readings for these metrics. Consequently, by the time the condition is recognised, it may have already impacted the cardiovascular and kidney systems.
BNH Hospital prioritises prevention. Patients undergo in-depth physical analysis to identify the root causes of excess weight and related bodily abnormalities, including “sick fat” accumulation. This allows for the creation of a comprehensive plan to manage weight and “sick fat” while simultaneously reducing health risks to cardiovascular and kidneys.
METABOLIC DEEP DISCOVERY
Detect hidden metabolic, hormonal, and health risks
to develop a personalised approach for long-term wellness.
The benefits of a simultaneous, three-system approach at BNH Cardiovascular Kidney Metabolic Centre (CKM)
- A focus on preventive care enables early detection, improving the likelihood of successful treatment and better long-term outcomes.
- Specialists across all three systems work in an integrated manner within the same department, sharing treatment data. A patient seeking care for an issue in one system effectively receives care for all three simultaneously.
- Redundancy in testing and treatment planning is minimised, saving both time and costs.
- Long-term health monitoring ensures continuity of care across all three systems, aligning the management of risk factors.
- Comprehensive, in-depth health screening plans target the root causes across all three systems, supporting accurate diagnosis and targeted treatment.
- Develops sustainable, healthy weight management plans are developed under specialist supervision, incorporating analysis of blood sugar, blood lipids, hormone levels, and underlying medical conditions.
24-hour emergency cardiac care is coordinated.
Advanced medical technology is utilised to support diagnosis and treatment, including Cardiac Catheterisation Laboratory (Cath Lab) services when clinically indicated.
A multidisciplinary approach involving specialised medical professionals, such as rehabilitation physicians, nutritionists and physiotherapists, provides comprehensive care to support the best possible quality of life for patients.
Personalised treatment plans are designed to mitigate risks across three key physiological systems while supporting long-term health, for instance through tailored nutrition and exercise programmes.
Warning signs of cardiovascular-kidney-metabolic (CKM) imbalances
You may currently show no signs of illness, and your general health check-up results, such as blood pressure, lipid levels, and blood sugar, might appear normal. However, underlying issues may still be present. If these conditions are not detected until symptoms develop, treatment may be more complex and outcomes may be less favourable than with early detection and management.
At-risk group: No symptoms detected yet
If any of the following risk factors apply to you, you may be at risk for cardiovascular-kidney-metabolic (CKM) issues, even if you are currently asymptomatic:
- Aged 40 or older
- Frequent consumption of foods high in salt or sugar, including fried, fatty, instant and ultra-processed foods
- Low water intake
- Regular smoking or alcohol consumption
- Insufficient rest, chronic stress, or lack of exercise
- Overweight, obesity, or a large waist circumference
- Family history of heart disease, kidney disease, diabetes, stroke, or sudden death
At-risk group: Symptoms already detected
If you are experiencing these health issues, you may be at increased risk of developing problems in other related systems. You should consult a doctor promptly to help slow disease progression and reduce further health risks.
High blood pressure, elevated blood lipid levels, high blood sugar levels or a high Body Mass Index (BMI)
- Diabetes or pre-diabetes
- “Sick Fat” conditions, such as visceral fat and fatty liver
- Chronic kidney disease or a history of abnormal kidney function test results
- Fatigue, palpitations, frequent fainting or an abnormally rapid heartbeat
- Desire to slow disease progression and prevent complications or recurrence
Group with no risk factors but seeking appropriate self-care
If you do not have any diseases, even if you do not fall into a high-risk group but are planning for long-term health maintenance, you should review in-depth data about your body to ensure your new self-care routine is suitable. This helps minimise the risk of adverse effects caused by lifestyle changes that may not align with your body’s specific needs.
- If you intend to start exercising seriously or plan to compete in challenging events such as marathons or triathlons, you should undergo a cardiac health check-up to assess your physical readiness.
- When planning weight loss through dietary changes, it is advisable to check your metabolic and kidney health. Restricting certain foods, especially if you have underlying absorption issues, can lead to nutrient deficiencies and metabolic imbalances. Conversely, increasing the intake of specific foods or supplements, such as extra protein or vitamins, to manage weight or build muscle can place an increased burden on the kidneys.
- If you are planning weight loss using medical interventions, such as weight-loss injections, medications, or supplements, you should assess your physical readiness and consider the potential side effects of these methods.
- For those planning for longevity and a high quality of life in their later years, even in the absence of apparent health risks, understanding your body’s specific data allows for more tailored and effective health planning.
Emergency Group: Immediate Medical Attention Required
If you experience any of the following symptoms, it constitutes a medical emergency where survival or recovery depends on the speed of medical intervention. Please contact the emergency department immediately:
- Sudden chest pain or tightness
- Pain radiating to the arm, neck, jaw, back, or shoulder
- Sudden shortness of breath, difficulty catching your breath, or inability to lie flat
- Breaking out in a cold sweat, heart palpitations, dizziness, or feeling faint
- Sudden facial drooping, limb weakness, or slurred speech
- Severely high blood pressure accompanied by a severe headache, chest tightness, or difficulty breathing
- Loss of consciousness during exercise or physical exertion, especially if this has never happened before
- Loss of consciousness without warning signs such as light-headedness, nausea, sweating, or a feeling of impending fainting
BNH Hospital Emergency Department Hotline: 02-632-1000. Staff are ready to assess symptoms and coordinate with specialist medical teams 24 hours a day, including facilitating examination and treatment in the Cath Lab when indicated.
The 5 Stages of CKM Health: When to Manage and What to Expect
Cardio-Kidney-Metabolic health issues may not manifest symptoms immediately. Instead, they may develop gradually until organ damage becomes apparent. Waiting until this stage can make it more difficult to slow disease progression and achieve successful treatment outcomes compared with early detection and management. By then, risks to other bodily systems may also have developed.
Stage 0: Optimal Cardio-Kidney-Metabolic Health
Health Profile: No health issues are present; no major risk factors.
Management Approach: Maintain good health and undergo age-appropriate health check-ups.
Goal: Prevent the development of risk factors that could lead to Stage 1.
Stage 1: Early Metabolic Imbalance
Health Profile: Warning signs appear, such as excess weight, fat accumulation, increased waist circumference, and insulin resistance.
Management Approach: Modify lifestyle through exercise, dietary control, adequate rest, stress management, and regular health check-ups.
Goal: Reduce fat accumulation, restore metabolic balance, and lower the risk of diabetes, heart disease, and kidney disease.
Stage 2: Presence of Risk Factors or Comorbidities
Health Profile: Clear presence of metabolic or kidney-related diseases or risk factors. Conditions may include hypertension, high triglycerides, type 2 diabetes, metabolic disorders, chronic kidney disease, or a combination of these issues.
Management Approach: Exercise and dietary control to manage blood sugar, blood pressure, lipid levels, and weight, while assessing cardiovascular and kidney function and receiving treatment tailored to the risk level.
Goal: Manage abnormalities before organ damage worsens.
Stage 3: Onset of Damage That May Be Asymptomatic
Health Profile: Patients may feel normal, yet bodily systems are already sustaining damage. Specialised testing reveals changes in the heart, blood vessels, or kidneys, even in the absence of clear symptoms.
Care Approach: Conduct a detailed assessment of damage, adjust treatment plans, and closely monitor cardiac, kidney, and metabolic systems.
Goal: Slow or halt disease progression, reduce the likelihood of medical emergencies, and lower risks to other bodily systems.
Stage 4: Established Cardiovascular Disease
Health Profile: This is the highest-risk stage requiring intensive care. Patients have clinically manifest cardiovascular disease, such as coronary artery disease, heart failure, atrial fibrillation, stroke, or peripheral vascular disease, and may also have concurrent kidney failure.
Care Approach: Provide standard disease treatment and prevent recurrence, while simultaneously managing blood sugar, blood pressure, lipids, weight, and kidney function.
Goal: Reduce recurrent events, preserve organ function, and maintain the best possible quality of life.
Proper health management, adherence to medical advice, and continuous treatment and monitoring can slow disease progression, reduce risks to other systems, and potentially shift certain CKM stages to a lower risk level.
BNH Cardiovascular Kidney Metabolic Centre (CKM) is fully equipped to care for your health at every stage, from the pre-symptomatic phase to medical emergencies. To ensure the most appropriate long-term care, it is important to note that early detection of cardio-kidney-metabolic issues increases the chances of successful treatment and reduces the risk of complications affecting other body systems. Therefore, regular health assessments are highly recommended.
A Comprehensive Long-Term Health Care Plan Covering 3 Key Systems
To create a personalised health care plan aimed at reducing disease risk and promoting health across the cardiovascular, kidney, and metabolic systems, a multidisciplinary medical team collaborates on screening, assessment, diagnosis, and the design of long-term treatment and care.
Step 1: Initial Health Risk Assessment
Regardless of whether the patient is already showing signs of illness, doctors conduct an initial risk assessment based on the following data:
- Genetic factors and family medical history
- Underlying conditions and current medications
- Behaviours and lifestyle patterns
- Weight, Body Mass Index (BMI), and waist circumference
- Blood sugar levels, lipid profiles, and blood pressure
- Kidney function
- Previous health check-up results
Patients should therefore prepare their previous test results, a list of medications and supplements, family medical history, and relevant treatment records for their appointment.
Step 2: Screening for Early-Stage Abnormalities
If certain risks are identified, doctors may consider appropriate additional screenings. Examples include Carotid Doppler Ultrasound to assess arterial wall thickness and plaque accumulation in patients who show no symptoms but have a family history of heart disease.
Targeted screening allows doctors to determine risk levels that initial check-ups might not fully reveal. This enables the planning of preventive care before disease onset, reduces complications, and minimises the risk of adverse effects on other related bodily systems.
Step 3: Assessing Cardiovascular, Kidney, and Metabolic Health Status
Doctors evaluate the screening data from Steps 1 and 2 to assess risk levels and establish treatment goals.
Step 4: Collaborative Planning by the Multidisciplinary Medical Team
Specialists in cardiology, nephrology, and metabolic medicine collaborate to design an integrated treatment plan aimed at slowing disease progression, reducing severity, and minimising health risks to other bodily systems. This includes a long-term health promotion plan covering nutrition and exercise.
Step 5: Continuous Monitoring for Better Long-Term Health
A multidisciplinary team monitors progress and adjusts care plans to prevent disease recurrence, slow the decline in organ function, and reduce long-term complications. Nutrition and exercise plans are also modified to suit the patient’s evolving health status.
Health Check-up Services from BNH Hospital
BNH Cardiovascular Kidney Metabolic Centre (CKM) offers comprehensive health check-up services, ranging from general to in-depth screenings, enabling the detection of risks before symptoms appear. Screenings are conducted based on medical recommendations tailored to each individual’s health history; therefore, patients do not necessarily need to undergo every available test.
Metabolic System Assessment
- Physical examination (blood pressure, weight, BMI, and waist circumference)
- Blood glucose and HbA1c levels
- Blood lipid profile
- Creatinine and eGFR
- Urinary protein leakage (uACR)
- Thyroid hormone testing (based on clinical indications)
- Body composition analysis (InBody)
- Continuous Glucose Monitoring (CGM) (based on clinical indications)
- Risk assessment using PREVENT Equations (as appropriate)
Cardiovascular and Circulatory System Assessment
- Resting ECG/EKG
- Ankle-Brachial Index (ABI) for limb circulation
- Transthoracic Echocardiogram (TTE)
- Exercise Stress Test (EST)
- 24-hour ECG recording (Holter Monitor)
- 24-hour blood pressure monitoring (ABPM)
Kidney Function Assessment
- Kidney function tests (BUN, Creatinine, eGFR)
- Urinalysis
- Urine Albumin-to-Creatinine Ratio (UACR)
- Electrolyte balance
- Renal and urinary tract ultrasound
Specialised In-depth Testing (based on clinical indications)
- Transesophageal Echocardiogram (TEE)
- Dobutamine Stress Echocardiogram
- Tilt Table Test
- CT Calcium Score
- Carotid Doppler Ultrasound
- Cardiac CT Angiography (CTA/CCTA)
- Cardiac Catheterisation (Cath Lab) Procedures
2C1U: A Popular In-depth Health Check-up Package
As we age, blood vessel walls lose elasticity. Combined with the accumulation of fat and calcium deposits, the walls thicken and obstruct blood flow. Factors such as age (over 40), smoking, alcohol consumption, excess weight, diabetes, chronic kidney disease, infections, and systemic inflammation cause these deposits to accumulate differently in each individual.
Standard health check-ups provide data on blood pressure, lipid profiles, and blood sugar levels, offering a preliminary risk assessment. However, they often lack critical information, specifically the thickness of blood vessel walls. Knowing this allows doctors to accurately assess risk and plan targeted prevention or treatment, thereby reducing the likelihood of vessel blockages. Such blockages can lead to ischaemic heart disease if they occur in the heart, or stroke if they affect the blood vessels supplying the brain.
Additionally, the 2C1U package includes an in-depth lung cancer screening, addressing a disease that has become increasingly common due to rising pollution levels. This screening detects signs of the disease in greater detail than a standard chest X-ray, enabling early-stage detection.
Individuals concerned about their health can purchase the 2C1U in-depth health check-up package for targeted screening. Doctors will summarise the results and provide health management advice to mitigate risks or recommend further treatment if necessary.
Tests included in the 2C1U package are:
C – Cardiac CT Scan for Calcium Scoring:
Screening for coronary artery disease. High-speed computed tomography (CT) scans measure the amount of calcium or plaque in the coronary arteries and provide a numerical score. A high score indicates an elevated risk of ischaemic heart disease. Without treatment, this can lead to a heart attack (myocardial infarction) or sudden cardiac death.
C – Low-dose Computed Tomography (Low-dose CT) for Lung Cancer Screening
This low-radiation CT scan produces high-resolution 3D images, far superior to standard chest X-rays. It enables the detection of lung cancer at an early, asymptomatic stage, thereby increasing the chance of a cure to 90% and reducing the lung cancer mortality rate by 20%.
U – Carotid Doppler Ultrasound for Stroke Screening
This procedure uses high-frequency sound waves to examine the carotid arteries in the neck. It assesses blood flow to the brain and checks for calcium or fatty deposits (plaque) within the vessels. This helps evaluate the risk of stroke caused by arterial narrowing or blockage, or by blood clots breaking loose and obstructing downstream vessels, which can restrict or cut off blood supply to the brain, leading to cerebral ischaemia, paralysis, or death if not treated promptly.
Patients may choose to undergo these screenings individually; however, completing all three provides doctors with a comprehensive health overview covering the risks of these three serious, interrelated conditions. This allows for the development of an appropriate care plan and offers significant cost savings compared to undergoing the tests separately.
Meet the Multidisciplinary Team at CKM Centre
At BNH Hospital, we provide integrated care and comprehensive, continuous treatment planning. Our approach focuses on early disease detection, slowing disease progression, symptom control, preserving organ function, minimising complications and systemic impact, and promoting long-term holistic health.
BNH Cardiovascular Kidney Metabolic Centre (CKM) delivers patient care through the collaboration of specialists across various fields, including:
Cardiologists
Dr. Nopparat Panthongwiriyakul
Dr. Jiranut Cholteesupachai
Dr. Natthinee Mattanapojanat
Dr. Tachawut Tiensuntisook
Dr. Vorawan Luangjarmekorn
Dr. Wiwat Sanglertsilpchai
Dr. Sake Panyasang
Nephrologists
Dr. Nawaporn Assawasaksakul
Dr. Rapeepat Lekkham
Endocrinologists and metabolic specialists
Dr. Krittin Ousirimaneechai
Dr. Pimook Tepmongkol
Dr. Chotiwan Tanwattananikul
Furthermore, this team of specialists collaborates with a multidisciplinary team to ensure comprehensive and continuous care:
Nutrition and Rehabilitation Specialists
They develop personalised plans for nutrition, weight management, and exercise tailored to each patient’s health history, aiming for optimal treatment outcomes and long-term health maintenance.
Emergency Physicians and Care Coordination Teams
They ensure rapid emergency management, increasing survival rates and minimising the physical impact on the patient.
Frequently Asked Questions about CKM System
What is CKM?
Is a CKM health assessment necessary if I have no symptoms?
Who should undergo a CKM health risk assessment?
What does a CKM health assessment involve?
Is it necessary to undergo every single test?
What is the difference between a CT Calcium Score and a Carotid Doppler Ultrasound?
How does BNH Cardiovascular Kidney Metabolic Centre (CKM) manage weight?
What should I do if I suspect a cardiac emergency?