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The Rest is Kidneys podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

In this special Q&A episode, Prof Jeremy Levy, Dr Andrew Frankel, and specialist nurse Joana Teles tackle key CKD questions from primary care. They discuss CKD coding adjustments, NSAID safety, and the importance of optimising RAAS inhibitors and SGLT2 inhibitors. Practical guidance is given on prescribing, managing side effects, and using diuretics like furosemide effectively.

The hosts emphasise that while lifestyle changes are crucial, medication remains key to slowing CKD progression and reducing cardiovascular risk.

Take-Home Messages:

CKD Coding – Adjust ACR coding as values improve; coding helps with safe prescribing.
NSAIDs & CKD – Generally avoid, but occasional short-term use may be safe in mild CKD.
RAASi & SGLT2 Inhibitors – Maximise doses; SGLT2 inhibitors are transformative for CKD and heart failure.
Managing Risks – Address side effects proactively but don’t let concerns block treatment.
Diuretics & Fluid Balance – Furosemide isn’t nephrotoxic; use it to relieve symptoms.
Hyperkalaemia – Potassium up to 6 mmol/L is usually safe; use binders before stopping RAASi.
Lifestyle & Medications – Diet and exercise help, but medication is often essential.

Effective CKD management balances accurate coding, lifestyle changes, and optimised medication use. While lifestyle adjustments help, RAAS and SGLT2 inhibitors are key to slowing progression and reducing cardiovascular risk.

Primary care teams should confidently adjust treatment, manage side effects, and take a pragmatic approach to NSAIDs, diuretics, and hyperkalaemia. Proactive, evidence-based care ensures better long-term kidney health.

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

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The Rest is Kidneys podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

This podcast episode explores the intersection of chronic kidney disease (CKD) and heart failure, providing guidance for managing patients with both conditions. Hosts Prof Jeremy Levy and Andrew Frankel, consultant nephrologists, are joined by Dr Dominique Auger, a consultant cardiologist specialising in heart failure.

The discussion focuses on the shared pathophysiology of CKD and heart failure, optimising treatments, and addressing common clinical concerns in primary care.

Top Three Key Messages

1. CKD and Heart Failure Coexistence:

• CKD and heart failure frequently occur together, with CKD increasing the risk of cardiovascular disease and heart failure.
• Both conditions share overlapping treatments, including ACE inhibitors, ARBs, SGLT2 inhibitors, and MRAs, which improve survival, reduce symptoms, and decrease hospitalisations.

2. GFR Decline and Kidney Forgiveness:

• A decline in GFR is expected with effective therapies like RAS inhibitors and SGLT2 inhibitors.
• For heart failure with CKD, GFR reductions of up to 50% or creatinine increases to 260 µmol/L are acceptable, as kidneys often stabilise ("the kidneys forgive"). Therapy should continue with careful monitoring unless hyperkalaemia or other severe complications arise.

3. Role of Diuretics:

• Diuretics are essential for symptom control (e.g., relieving oedema and breathlessness) but have no prognostic benefit in heart failure.
• They are safe to use in CKD and heart failure, often requiring higher doses in CKD patients due to kidney resistance, and are useful for managing hyperkalaemia as well.

This episode underscores the importance of integrated, aggressive management of both CKD and heart failure, with a focus on optimising therapies that balance efficacy with patient safety.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub

Send us a text

The Rest is Kidneys podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

This episode provides practical advice for primary care professionals on reviewing medications and prescribing pain relief for patients with CKD. The discussion focuses on assessing kidney function using estimated GFR (eGFR), adjusting drug dosages, and safely managing pain relief without compromising renal health. The hosts explain how eGFR should be used instead of creatinine clearance for drug dosing decisions, while taking into account patient-specific factors such as body size and muscle mass to ensure accurate assessment.

Key considerations for medication reviews are covered, including drugs that require caution such as NSAIDs, Metformin, PPIs, and cardiovascular medications. The importance of dose adjustments, monitoring for complications like hyperkalemia, and following Sick Day guidance to prevent adverse effects during acute illness is highlighted.

For pain management, the episode outlines safe options for analgesics, including paracetamol, tramadol, and opioids like fentanyl and oxycodone, while stressing the need to avoid morphine due to the risk of metabolite accumulation and toxicity. Recommendations are provided for starting with low doses and titrating carefully, particularly for neuropathic pain treatments such as Gabapentin and Pregabalin.

Take-Home Messages:

1. Kidney Function Assessment – Use estimated GFR (eGFR) rather than creatinine clearance for drug dose adjustments, considering patient-specific factors like muscle mass.
2. Medication Reviews – Avoid regular NSAIDs, adjust Metformin dosing (reduce below eGFR 45, stop below 30), review PPIs and cardiovascular drugs, and follow Sick Day rules to guide temporary medication pauses during illness.
3. Pain Management – Use paracetamol as first-line analgesia, avoid morphine, and opt for lower doses of tramadol, oxycodone, or fentanyl for stronger pain relief. Minimise long-term NSAID use and review topical gels due to absorption risks.

This episode offers clear, NICE-aligned guidance to support safer prescribing practices in CKD.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub