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The For Kidneys Sake 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 For Kidneys Sake 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 For Kidneys Sake 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

Send us a text

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

In this episode, Professor Jeremy Levy, Dr. Andrew Frankel, and clinical lead kidney nurse specialist Joana Teles discuss how to effectively educate and empower patients with Chronic Kidney Disease (CKD), focusing on delivering a CKD diagnosis with clarity and reassurance, addressing common misconceptions, and encouraging patient engagement during short consultations. Joanna highlights the importance of framing discussions around ‘kidney health’ rather than ‘kidney disease’ and shares practical tips for encouraging patients to take an active role in their care. Resources like the Know Your Kidneys education programme are vital tools for patient learning and support.

The discussion highlights that there are practical steps to help reduce fear and unnecessary worry so that patients can be reassured and empowered. For example, it is important to explain that the term ‘chronic’ describes the duration of the condition rather than its severity and to clarify that CKD stages are not comparable to cancer stages. To encourage patient involvement and understanding, Joana continues by outlining actions such as having regular ‘kidney health checks’ to monitor kidney function, protein levels, and blood pressure. The benefits of commonly used medications, such as Ramipril and SGLT2 inhibitors, are also explained. The conversation concludes by stressing the value of simple, actionable steps, such as keeping track of medications and bringing blood pressure readings to appointments, which can help patients feel more confident and engaged in managing their kidney health.

Top Three Takeaways:

1. Use clear, reassuring language to explain CKD and focus on maintaining kidney health.
2. Promote regular "kidney health checks" and educate patients on lifestyle and medication management.
3. Encourage small, actionable steps to increase patient engagement, such as participating in education programmes like Know Your Kidneys.

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

In this episode, Jeremy Levy and Andrew Frankel discuss the game-changing role of SGLT2 inhibitors in treating chronic kidney disease (CKD). These drugs, initially developed for diabetes, have shown remarkable benefits in slowing CKD progression, reducing cardiovascular risks, and delaying dialysis. They cover the key patient groups, prescribing tips, and how to use these medications safely and effectively.

Top Three Takeaways:
1. Broad Benefits Beyond Diabetes:
SGLT2 inhibitors significantly slow CKD progression, reduce cardiovascular risks, and delay the need for dialysis, benefiting patients with or without diabetes.

2. Who Should Get Them:

• Heart failure patients.
• CKD patients with or without diabetes and/or albuminuria.
• Patients with GFR between 20-45, regardless of urine albumin levels.

3. Safety and Usage Tips:

• Avoid type 1 diabetes or "type 1-like" patients.
• Manage minor side effects (e.g., fungal infections) and provide "Sick Day Guidance" to minimise risks like ketoacidosis.

This episode provides practical insights and actionable advice for clinicians managing CKD patients.

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

In this episode, Jeremy Levy and Andrew Frankel discuss the role of renin-angiotensin-aldosterone system inhibitors (RAASi) in the management of chronic kidney disease (CKD), looking deeper into the mechanisms, benefits and practical considerations of using RAASi. 

They cover when to initiate these medications, the importance of maximum dosing, monitoring kidney function, and managing side effects like changes in GFR and potassium levels.

Key Takeaways:

1. RAASi Benefits Beyond Blood Pressure:
   • These drugs lower blood pressure, slow CKD progression, and provide cardiovascular protection through mechanisms independent of blood pressure control.
   • Maximum dosing is essential for optimal kidney and heart protection.
2. Monitoring and Managing GFR Changes:
   • A GFR drop of up to 25% after starting RAASi is not a cause for concern.
   • Clinicians should reassure patients and recheck levels to ensure stability.
3. Potassium Management:
   • Mild to moderate increases in potassium (up to 6 mmol/L) are common and generally not an emergency.
   • Careful monitoring, addressing potential contributing factors, and avoiding unnecessary panic are key.

This episode provides practical insights and actionable advice for clinicians managing CKD patients.

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

In this episode, consultant nephrologists Jeremy Levy and Andrew Frankel from Imperial College Healthcare NHS Trust are joined by Dr Kuldhir Johal, a GP and interim cardiovascular and renal lead. 

Together, they discuss a critical aspect of chronic kidney disease (CKD) management in primary care: the importance of accurate coding to improve diagnosis and patient outcomes.

This episode focuses on how CKD remains underdiagnosed due to gaps in coding, confidence among healthcare providers, and primary care capacity. Dr Johal explains that CKD affects a significant portion of the population, but proper diagnosis often lags. 

The discussion explores strategies to bridge this gap, like integrating albumin-to-creatinine ratio (ACR) testing into regular health checks for high-risk individuals. The speakers emphasise the collaborative tools and resources being developed to make CKD management a standard, streamlined practice in primary care.

Three Main Takeaways:

1. Early Detection through Comprehensive Testing

For patients at risk of CKD, such as those with diabetes, hypertension, or cardiovascular disease, a complete kidney health check should include both GFR (glomerular filtration rate) and ACR tests. These tests allow for early CKD detection and timely interventions to slow disease progression.

2. Accurate and Consistent Coding

Consistently coding CKD diagnoses in primary care records (with both EGFR and ACR codes) is essential for monitoring patient health, ensuring continuity of care, and ultimately improving CKD detection rates and patient outcomes.

3. Patient Involvement in Diagnosis

Engaging patients in their CKD diagnosis and educating them on kidney health empowers them to make informed decisions and adopt lifestyle adjustments that support kidney function, underscoring the value of proactive, patient-centred care.

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

In this episode of the North West London Kidney Care Podcast, Consultant Nephrologists Andrew Frankel and Jeremy Levy from Imperial College Healthcare NHS Trust discuss the diagnosis and management of chronic kidney disease (CKD) in primary care. They focus on interpreting blood test results, such as low GFR and high creatinine, and emphasise the importance of distinguishing between chronic kidney disease and acute kidney injury. 

The conversation also highlights the role of past blood results, urine dipstick tests, and further investigations like ACR and tests for underlying causes such as diabetes or myeloma. This episode provides practical insights for healthcare professionals managing CKD in primary care.

Key Takeaways:

1. Always distinguish between chronic kidney disease (CKD) and acute kidney injury by reviewing previous blood results and assessing the patient's overall health status.
2. Don't rely solely on abnormal GFR or creatinine levels; investigate the underlying cause of CKD and consider further tests, such as urine dipstick tests and ACR, especially in patients with diabetes or hypertension.
3. The presence of both blood and protein in the urine may indicate more serious conditions, such as glomerulonephritis, and should prompt further investigation or referral to secondary care.

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

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

In this episode, nephrologists Professor Jeremy Levy and Dr Andrew Frankel, both from Imperial College Healthcare NHS Trust, explore strategies for managing Chronic Kidney Disease (CKD). The conversation focuses on essential lifestyle and health interventions to improve kidney health, particularly for patients newly diagnosed with CKD.

The hosts discuss how managing CKD should be viewed in the context of cardiovascular health. They highlight the importance of lifestyle changes, such as diet, exercise, smoking cessation, and weight management, which mirror approaches taken for cardiovascular risk. 

Both emphasise the role of patient engagement and education, encouraging patients to take ownership of their health by understanding their blood pressure, glucose levels, and the long-term impacts of CKD.

Blood pressure control is discussed in detail, with a focus on setting personalised targets based on factors such as age, comorbidities, and the severity of kidney disease. Frankel stresses the need for patients to self-monitor their blood pressure and understand their target ranges, typically between 120-140 systolic and less than 90 diastolic, but adjusted for albuminuria or frailty.

The episode also addresses managing diabetes in CKD patients, noting the importance of tight glucose control early in diabetes and the need to relax targets as CKD progresses to avoid hypoglycaemia.

Key takeaways include the critical role of lifestyle interventions, individualised blood pressure management, and tailored glycaemic control. Future episodes will cover specific medications and more advanced treatment strategies for CKD.

We hope you enjoyed this episode.

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

For Kidney's Sake series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

In our first For Kidneys Sake episode, Dr Andrew Frankel and Prof Jeremy Levy, Consultant Nephrologists at Imperial College Healthcare NHS Trust, discuss hyperkalaemia (high potassium levels), particularly in patients with chronic kidney disease (CKD). They explore when clinicians should be concerned about elevated potassium levels, the causes behind hyperkalaemia, and the best approaches to managing it in primary care. The episode aims to demystify the condition, provide clarity on when action is necessary, and offer practical tips for managing hyperkalaemia without unnecessary panic.

Key points include understanding spurious hyperkalaemia in primary care, recognising when potassium levels are truly concerning, and the role of commonly prescribed medications such as ACE inhibitors and angiotensin receptor blockers. The doctors also discuss treatment options like potassium binders and diuretics, emphasising the importance of maintaining heart and kidney-protective medications where possible. The episode also touches on the role of diet in managing potassium levels, clarifying misconceptions about potassium-rich foods and their impact.

Key Takeaways:

Spurious Hyperkalaemia: Often caused by delayed blood sample processing in primary care.

When to Act: Potassium levels above 6.5 mmol/L warrant urgent action. Levels between 5.5-6.5 mmol/L require follow-up but are not emergencies.

Medications: Certain medications, especially ACE inhibitors, ARBs, and mineralocorticoid receptor antagonists, can cause high potassium but are essential for heart and kidney health. New potassium binders, such as Lokelma and Veltassa, can help manage potassium without discontinuing these vital drugs.

Dietary Considerations: Bananas are not the only source of potassium. Many fruits and vegetables contain high levels, but stopping their consumption is not advisable. A balanced approach to diet is key.

Educational Resources: Potassium education sheets are available on the North West London CKD site.

This episode is a practical guide for primary care clinicians on managing potassium levels in CKD patients and balancing treatment urgency with patient well-being.

We hope you enjoy this episode. 

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)

Renal association: Management of hyperkalaemia in the community (algorithm) APPENDIX 5 - HYPERKALAEMIA ALGORITHM IN COMMUNITY.pdf (ukkidney.org)

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