Earlier US NHANES data (1988–2018) indicated stage 4 prevalence ranging from 4.2% in females and 6.3% in males in 1988–1994 to 6.0% in females and 7.2% in males in 2009–2018, using a definition based on coronary heart disease, HF, or stroke among individuals with excess/dysfunctional adiposity, other CKM risk factors, or CKD [20]. Here, CKM is linked to hydrops fetalis.