Cardiovascular-Kidney-Metabolic Syndrome Registry

Cardiovascular-Kidney-Metabolic Syndrome (CKMS) framework proposed by the American Heart Association to recognize the interconnected relationship between metabolic disorders, chronic kidney disease, and cardiovascular disease. Rather than considering these conditions independently, the CKMS framework emphasizes their shared pathophysiology and progressive nature, highlighting the need for integrated risk assessment and management across the disease spectrum.

India is experiencing a rapid rise in obesity, hypertension, type 2 diabetes mellitus, dyslipidaemia, chronic kidney disease, and cardiovascular disease. These conditions frequently coexist and contribute substantially to morbidity, mortality, and healthcare expenditure. Despite this growing burden, existing surveillance systems and disease registries primarily focus on individual diseases, resulting in fragmented information that limits understanding of how cardiovascular, kidney, and metabolic disorders interact and progress over time.

The absence of comprehensive real-world data on CKMS represents an important evidence gap in India. Understanding the distribution of CKMS stages, associated clinical characteristics, healthcare utilization, treatment practices, and longitudinal changes in disease status is essential for informing clinical practice, strengthening preventive strategies, and supporting healthcare policy. A multicentre registry provides an opportunity to systematically collect standardized clinical information from routine care settings and evaluate CKMS within the Indian healthcare context. Prospective observational registry of adults receiving routine clinical care to assess CKMS staging, progression, management, and outcomes without assignment of study interventions.

This registry has been established to generate prospective, real-world evidence on CKMS across tertiary care hospitals in India. Information collected through the registry will facilitate characterization of the CKMS spectrum, including demographic and clinical profiles, anthropometric measures, cardiometabolic risk factors, renal function, cardiovascular status, laboratory parameters, medication use, and patient-reported quality of life. Longitudinal follow-up will enable assessment of changes in disease stage and clinical characteristics during routine clinical care.

The registry is designed to reflect routine clinical practice without influencing treatment decisions. All diagnostic investigations, treatment decisions, and follow-up care will be performed according to the treating physician's clinical judgment and local standard of care. Participation in the registry will not require any experimental intervention or modification of routine medical management.

Data will be collected using standardized electronic case report forms within a secure REDCap database to ensure consistency across participating centres. Standardized operating procedures, investigator training, built-in data validation rules, centralized data monitoring, and routine quality assurance processes will be implemented to promote data completeness, accuracy, and consistency. Participant confidentiality will be maintained through coded study identifiers, restricted database access, secure storage systems, and compliance with applicable ethical, regulatory, and institutional data protection requirements.

The findings from this registry are expected to establish one of the first comprehensive multicentre datasets describing CKMS in the Indian population. The resulting evidence will improve understanding of the epidemiology and clinical profile of CKMS, support identification of high-risk populations, describe contemporary management practices, and provide a foundation for future observational studies, implementation research, clinical trials, and evidence-based strategies aimed at reducing the burden of cardiovascular, kidney, and metabolic diseases in India.

Inclusion criteria

• Adults ≥18 years visiting select tertiary care hospitals AND
• Presenting with signs and/or symptoms of CKMS :

2.1. Adiposity i.e., Body Mass Index > 23, and/or large waist circumference [women: ≥ 80 cm; men: ≥ 90 cm] AND/OR 2.2. Metabolic syndrome i.e., new or a known case of hypertension, type-2 diabetes, dyslipidaemia, chronic kidney disease, and/or PCOS.

AND/OR 2.3. Presenting with signs of subclinical CVD and/or with a history of clinical CVD with metabolic syndrome AND

• Willing and able to provide informed consent.

Exclusion criteria

• Stage 0 CKMS i.e., a healthy state characterized by normal body weight, absence of metabolic risk factors such as hypertension, type-2 diabetes, dyslipidemias, preserved kidney function with no evidence of CKD, and no subclinical or clinical manifestations of CVDs.
• Neuro-cognitive, psychiatric, or any surgical conditions which prevents in obtaining reliable clinical data.
• Any surgical and/or medical condition that is likely to prevent the participant from complying with the requirements of the study or completing the study.
• Participants already taking part in another clinical trial.
• Pregnant and/or lactating women.