AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Stable Prevalence of Concurrent Metabolic, Hypertensive, and Chronic Kidney Disease Abnormalities Despite Rising Metabolic Dysfunction Among US Adults: A NHANES Analysis, 2003-2020
By Sajjad M, Sajjad A, Amer R et al.
Background: The AHA 2023 CKM framework integrates metabolic, kidney, and cardiovascular risk across a staging continuum. Whether rising metabolic dysfunction among US adults has translated into increasing concurrent prevalence of metabolic, hypertensive, and CKD abnormalities remains uncharacterized. Methods: Using NHANES 2003-2020 (9 cycles; n=48,991 adults ≥20 years), we applied complex survey weights (WTMEC2YR, SDMVPSU, SDMVSTRA) to estimate weighted prevalence of CKM components per cycle. Metabolic dysfunction was defined as obesity (BMI≥30), diabetes (FPG≥126 mg/dL or HbA1c≥6.5%), or prediabetes (FPG 100-125 or HbA1c 5.7-6.4%). Hypertension was defined as mean SBP≥130 mmHg. CKD was defined as eGFR<60 mL/min/1.73m ² (CKD-EPI 2021, primary analysis). A secondary robustness analysis used eGFR<60 or UACR≥30 mg/g across 2009-2020 (6 cycles). Trend significance was assessed using survey-weighted logistic regression. Results: Metabolic dysfunction prevalence rose substantially from 47.3% (2003-2004) to 67.0% (2017-2018). Despite this, concurrent prevalence of all three abnormalities remained stable: 1.1-1.8% using eGFR-based CKD (trend OR per year 1.003; p=0.704) and 3.7-5.3% using full CKD definition (trend OR 1.019; p=0.063). CKD prevalence remained stable at 3.0-4.0% across all cycles. Conclusions: Rising metabolic dysfunction among US adults from 2003 to 2020 was not accompanied by a corresponding increase in concurrent hypertensive and CKD abnormalities at the population level. These findings suggest a dissociation between worsening upstream metabolic burden and downstream multi-system cardiometabolic-renal co-occurrence, warranting further investigation.