By the time Rajesh Mehta turned 52, he was a compliant patient. He took his diabetes medication regularly, met his endocrinologist every quarter and regulated his diet. Living in Pune and working long hours at a desk job, he believed he was doing enough to stay healthy. Then his ankles began to swell.
He ignored it at first, blaming fatigue and long commutes. But breathlessness followed, creeping into ordinary routines like climbing a single flight of stairs. A visit to a cardiologist revealed early-stage heart failure. Months later, routine blood tests pointed to declining kidney function, and a nephrologist confirmed the onset of chronic kidney disease. Rajesh was bewildered. How had a blood sugar problem turned into heart and kidney disease?
Truth is it was never a blood sugar problem. For decades, medicine has divided the human body into neat territories. The heart belonged to the cardiologist, kidneys to the nephrologist, hormones to the endocrinologist. “While this structure made sense when medical knowledge was limited, science today tells us a different story. The heart, kidneys, and pancreas are not isolated players but interconnected, constantly communicating with each other. When one begins to fail, the others rarely remain unaffected,” says Prof (Dr) Dorairaj Prabhakaran, president-elect, World Heart Federation, executive director of Centre for Chronic Disease Control.
This interconnected system, often described as the cardio-renal-metabolic axis, is becoming central to how doctors understand chronic diseases. For countries like India, where diabetes, heart disease and kidney disorders are rising simultaneously, recognising this connection is no longer optional, it is essential.
In Rajesh’s case, years of elevated blood sugar had quietly damaged his blood vessels. His kidneys, which filter vast quantities of blood every day, began losing their efficiency. As waste products and excess fluid accumulated, the heart was forced to pump harder to circulate blood through an increasingly strained system. At the same time, metabolic imbalance triggered hormonal and inflammatory responses that further burdened both organs. What appeared to be separate illnesses were, in reality, different expressions of a collective breakdown.
A silent chain reaction inside the body
To understand the link, it is important to start with diabetes. “When blood sugar levels remain high for years, they damage blood vessels throughout the body. The kidneys, which filter nearly 180 litres of blood every day, are particularly vulnerable. Over time, this leads to chronic kidney disease. When the kidneys begin to lose their filtering ability, toxins and excess fluid start accumulating in the bloodstream. This increases pressure on the heart, forcing it to work harder. Gradually, the risk of heart failure, heart attacks and stroke rises sharply,” says Dr Prabhakaran.
The pancreas is also at the centre of this metabolic system. It maintains blood sugar levels through insulin production. “When this balance is disturbed, as it happens in Type 2 diabetes, it unleashes a hormonal and pro-inflammatory response that affects the kidneys and cardiovascular system as well. In other words, injury to one organ has a domino effect on all the other organs,” he explains.
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Rajesh’s turning point came when he enrolled in an integrated cardiometabolic clinic, a model that is slowly gaining ground. Instead of fragmented consultations, he underwent comprehensive evaluation designed to examine how his conditions interacted. Specialists reviewed his results together rather than in isolation, and made treatment decisions collectively.
They adjusted medication choices to reflect emerging evidence that some modern diabetes therapies also protect heart and kidney function. They rejigged his diet to reduce strain across all three systems. Exercise goals followed his cardiac tolerance, metabolic control and kidney safety. He was no longer managing three diseases separately. He was managing one interconnected condition.
Eighteen months later, his health stabilised. Kidney function decline slowed significantly. Breathlessness reduced. Hospital visits became less frequent. Everyday activities no longer felt like endurance tests.
“A cardiologist may stabilise heart function without addressing early kidney damage. An endocrinologist may control blood sugar without fully accounting for cardiovascular risk. So let’s have a screening process designed to detect kidney problems early on for those suffering from diabetes, where the patient is at the front and centre of care and not the individual disease,” says Dr Prabhakaran.
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Treatment regimens should also take into account the effects of medication on all three conditions at once. “The good news is that there are already signs that emerging treatments for diabetes are also effective for the other two conditions,” he adds.
Rethinking the future of care
Prevention is equally important. So we have to move towards more integrated, preventive and patient-centred models of care. Dr Prabhakaran advocates early screening as cardiometabolic diseases often develop silently for years before symptoms appear. “Screening for blood pressure, blood sugar and kidney function together can identify risks early. Balanced nutrition, regular physical activity, weight management and smoking cessation can significantly reduce the burden on the heart, kidneys and pancreas together,” he says.
