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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)

The For Kidneys Sake podcast series, returns with refreshed episodes from our earlier series. With over 30 episodes and 15,000 listeners, we’re revisiting key topics while we prepare our next series. 

In this episode, Prof Jeremy Levy and Dr Andrew Frankel explore a common and often overlooked clinical question: what impact do supplements, herbal remedies, and recreational drugs have on people with chronic kidney disease (CKD)?

From creatine and high-dose vitamins to anabolic steroids, ketamine, and traditional herbal medicines, this episode challenges the assumption that “natural” means safe. The discussion highlights the importance of asking patients directly about non-prescribed products and explains how some substances can either harm the kidneys or confuse clinical assessment. The core message remains unchanged: creatine is not nephrotoxic but can affect creatinine readings, herbal remedies may be harmful and should be avoided, and high-dose vitamin C and inappropriate vitamin D use can pose risks in CKD.

Key Takeaways

Ask directly about supplements, herbal remedies, and recreational drugs, they are often missed 

Standard multivitamins are generally safe, but high-dose vitamin C and vitamin D can be harmful 

Creatine can raise creatinine and lower eGFR without indicating kidney disease 

Anabolic steroids and ketamine carry serious kidney and bladder risks 

Herbal remedies may be nephrotoxic or interact with medications and should be avoided in CKD 

Use a full assessment (ACR, urine dipstick, BP, imaging), not creatinine alone

References: 

Creatine and kidneys:  Nutrients 2023, 15, 1466.   doi.org/10.3390/nu15061466 

Herbal medicines and CKD; Nephrology 15 (2010) 10–17   doi:10.1111/j.1440-1797.2010.01305.x 

Herbs and more: Drug stewardship for people with chronic kidney disease; towards effective, safe, and sustainable use of medications:  Nat Rev Nephrol. 2024 June ; 20(6): 386–401. doi:10.1038/s41581-024-00823-3 

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

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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 is a refreshed re-release of “Sweet Urine – Good Times Never Seemed So Good”, one of our early For Kidneys Sake podcasts, revisited to reflect how quickly the evidence base around SGLT2 inhibitors has evolved. Originally developed as glucose-lowering therapies, drugs such as dapagliflozin, empagliflozin and canagliflozin are now firmly established as powerful cardiorenal protective agents. Since the first release, further studies have strengthened the evidence that these medications slow progression of chronic kidney disease (CKD), reduce heart failure events, and improve survival, even in people without diabetes. 

Updated NICE guidance now places SGLT2 inhibitors alongside metformin as foundational therapy in type 2 diabetes, marking a major shift in clinical practice.

In this episode, we revisit who should receive SGLT2 inhibitors, how to start them safely, and how to manage common concerns in primary care. The discussion reinforces that these drugs should be considered in patients with CKD, heart failure, and diabetes, often irrespective of albuminuria or diabetic status. Practical prescribing advice remains unchanged: select patients carefully (particularly excluding those at risk of ketoacidosis), give clear sick day guidance, and be aware of manageable side effects such as genital fungal infections. Overall, this refreshed episode highlights just how central SGLT2 inhibitors have become in modern kidney and cardiovascular care, and why clinicians should feel confident using them.

Top Take aways: 

This is a refreshed episode: A re-release of one of our early podcasts, now updated with stronger evidence and evolving guidance on SGLT2 inhibitors. 

Think beyond diabetes: SGLT2 inhibitors are now key cardiorenal drugs—protecting kidneys and reducing heart failure and mortality, even in people without diabetes. 

Use them early and widely: Indicated in CKD, heart failure (any ejection fraction), and type 2 diabetes—often regardless of albuminuria. 

Safe to start with simple rules: Avoid in type 1 diabetes or high DKA risk, give sick day guidance, and adjust insulin/sulfonylureas if needed. 

Big benefits, small risks: Side effects are usually mild and manageable, while benefits in slowing CKD progression and reducing cardiovascular events are substantial.

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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 is a refreshed re-release of our very first For Kidneys Sake podcast, updated to reflect current practice while reinforcing the core messages that remain just as relevant today. 

Despite increased awareness, we are still seeing patients with chronic kidney disease (CKD) being referred urgently for potassium levels that are only mildly elevated. This episode revisits how to interpret potassium results correctly, including recognising spurious hyperkalaemia, understanding when repeat testing is appropriate, and being clear that levels in the 5.5–6.0 mmol/L range are usually not an emergency. Urgent action is typically reserved for levels above 6.5 mmol/L or when there are clinical concerns.

The refresh also highlights what has strengthened since the original release: even greater evidence supporting the continuation of RAAS inhibitors (ACE inhibitors, ARBs, and MRAs) in CKD and heart failure, alongside the growing role of newer potassium binders such as Lokelma and Veltassa to help patients stay on these vital therapies. We also revisit the persistent myth around dietary potassium—bananas are not the problem—and emphasise that restrictive diets are rarely the solution. 

This updated episode offers reassurance, clarity, and practical guidance, while staying true to the original aim: reducing unnecessary panic and supporting confident, evidence-based management of hyperkalaemia in primary care.

This is a refreshed classic: A re-release of Episode 1, reinforcing key messages with updated evidence and current practice. 

Don’t panic with mild elevations: Potassium levels of 5.5–6.0 mmol/L are usually not an emergency, repeat and review before acting. 

Check for spurious results: Delayed sample processing is a common cause of falsely high potassium in primary care. 

Keep life-saving medications going: ACE inhibitors, ARBs and MRAs should not be stopped unnecessarily, use potassium binders if needed. 

Bananas aren’t the problem: Dietary restriction alone is rarely effective, focus on overall management rather than blaming specific foods.

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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)

What are patients really asking when they’re told they have chronic kidney disease? 

In this insightful and open episode, Sister Joana Teles steps out from behind the scenes to bring frontline wisdom from the “Know Your Kidneys” education programme. From the deceptively simple (“Is protein in my urine serious?”) to the quietly worrying (“Can my kidneys improve?”), Joana unpacks the real concerns patients carry and challenges clinicians to rethink how we communicate CKD with clarity, confidence, and compassion.

Prof Jeremy Levy and Dr Andrew Frankel join the conversation to tackle myths, refine messaging, and emphasise the power of early intervention. Along the way, they cover everything from medication fears and heredity to diet, exercise, and when (not) to refer. 

The result? A practical, witty, and highly usable guide for primary care clinicians navigating early CKD conversations.

Top 5 Takeaways

1. Protein in urine = CKD (even with normal GFR) > Patients often hear “your kidneys are fine,” but proteinuria alone signals kidney damage and should be labelled and acted on.

2. CKD can “improve” > While eGFR rarely rises, reducing albuminuria meaningfully lowers risks of kidney failure and cardiovascular disease. That’s a win worth explaining.

3. Language matters > Avoiding the term “chronic kidney disease” can create confusion. Clear, honest terminology (with reassurance) empowers patients.

4. Most CKD isn’t hereditary > Aside from conditions like polycystic kidney disease, CKD is usually linked to diabetes, hypertension, and cardiovascular risk.

5. Primary care leads early CKD > Most patients don’t need a nephrologist. With the right tools, knowledge, and confidence, primary care teams are the experts.

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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)

What should you actually eat if you’ve just been told you have chronic kidney disease?

It’s one of the first questions patients ask and unfortunately, the internet often makes the answer far more confusing than it needs to be. In this episode of For Kidneys Sake, Dr Andrew Frankel and Prof Jeremy Levy are joined by renal dietitian Lina Johansson to cut through the noise and explain what people with early CKD (stages 2–3) really need to know about diet.

Rather than restrictive lists of forbidden foods, Lina explains why the focus should be on a cardio-renal-metabolic friendly diet: more fruits, vegetables, and whole grains, fewer ultra-processed foods, and sensible salt reduction. The conversation tackles common myths from unnecessary potassium restrictions to the modern obsession with high-protein diets and offers practical advice clinicians can confidently share with patients. 

Top 5 Takeaways

1. Most online “renal diet” advice is for advanced CKD — Much of the information patients find online is designed for people with late-stage kidney disease or dialysis, not those with early CKD.

2. Early CKD diets should focus on heart-healthy eating — A cardio-renal-metabolic friendly diet emphasises fruits, vegetables, whole grains, and healthier protein choices.

3. Potassium restriction is usually unnecessary — Patients with CKD stages 2–3 typically do not need to restrict potassium unless blood levels rise or certain medications require monitoring.

4. Ultra-processed foods are the real dietary villain — Reducing foods with additives, preservatives, and high salt content can improve blood pressure, metabolic health, and kidney outcomes.

5. Avoid high-protein trends — Extra protein shakes, bars, and supplements may accelerate kidney decline; moderation and more plant-based protein sources are preferable.

Resources Mentioned in This Episode:

KidneyWise
https://kidneywise.co.uk

Kidney Care UK – Kidney Kitchen 
https://www.kidneycareuk.org/kidney-kitchen/

Kidney Research UK
https://www.kidneyresearchuk.org

NHS Website
https://www.nhs.uk

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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)

An ultrasound report lands in your inbox. It mentions a cyst. Or a bright kidney. Or “thin cortex.” Or asymmetry. And suddenly, what was meant to reassure becomes a source of anxiety. In this highly practical episode, Prof Jeremy Levy and Dr Andrew Frankle tackle the six most common renal ultrasound findings that trigger GP referrals and explain what actually matters (and what really doesn’t).

From simple cysts and Bosniak classifications to angiomyolipomas, echogenic kidneys, cortical thinning, scars, and asymmetric kidneys, this episode cuts through the noise. The golden rule? Context is everything. Kidney health checks, eGFR, urine ACR, blood pressure, trump scan wording almost every time. Clear, calm, and clinically grounded, this is 15 minutes that could save you hours of unnecessary worry and referrals. Listen in and interpret with confidence.

Top 5 Takeaways

1. Simple cysts are simple - Bosniak 1 or 2 cysts need no follow-up. Reassure and move on. Complex cysts, however, go to urology — not nephrology.

2. Angiomyolipomas rarely matter - If under 40mm, they’re almost always benign and only need one follow-up scan at 12 months. Refer only if >40mm or in women of childbearing age.

3. “Bright kidneys” mean nothing without context - Check eGFR, urine ACR, and blood pressure. If all normal, ignore the scan comment.

4. Thin cortex or scarring is usually congenital - In patients with normal kidney health checks, these findings are benign variants. In younger patients with suboptimal GFR, code as G2 and monitor annually.

5. Asymmetry is common - A 1cm size difference is often physiological. Only worry if there’s uncontrolled hypertension, rapid GFR decline, pulmonary oedema, or significant size discrepancy.

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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)

For years, diabetic kidney disease felt frustratingly static: ACE inhibitors, ARBs… and then very little else. 

In this episode, Porf Jeremy Levy and Dr Andrew Frankel unpack why that era is finally over. With SGLT2 inhibitors already changing practice, attention now turns to two newer players finerenone and semaglutide and how they meaningfully reduce kidney failure, cardiovascular events, and even mortality. The hosts explore why finerenone is not just “spironolactone with a new name,” and why nephrologists (and primary care clinicians) suddenly find themselves spoiled for choice.

But with progress comes complexity. How do we sequence these drugs? Who benefits most? How do we explain to patients why another tablet matters when they “feel fine”? 

From potassium monitoring and GFR thresholds to lifetime risk conversations and real-world prescribing barriers, this episode is a practical, optimistic guide to modern diabetic kidney disease care and a rallying call to help patients avoid dialysis, heart attacks, and strokes in the decades ahead. 

Top 5 Takeaways

1. Diabetic kidney disease has entered a new treatment era - After decades of stagnation, we now have multiple therapies that genuinely slow progression and reduce hard outcomes.

2. Finerenone is different from spironolactone - It’s kidney-protective in type 2 diabetes, with fewer endocrine side effects and strong trial evidence.

3. Hyperkalaemia risk is real but manageable - Baseline potassium, GFR, NSAIDs, constipation, and follow-up labs matter more than fear.

4. Semaglutide is now a kidney drug too - Beyond glucose and weight, it delivers major renal, cardiovascular, and mortality benefits.

5. The biggest challenge is communication, not pharmacology - Helping patients understand long-term risk and benefit is central to success.

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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 For Kidneys’ Sake, Professors Jeremy Levy and Dr Andrew Frankel speak with Beverley Bostock, Advanced Nurse Practitioner in primary care, Editor-in-Chief of Practice Nurse Journal, and President-Elect of the Primary Care Cardiovascular Society. The discussion examines the expanding role of primary care nurses in the management of long-term conditions, including diabetes, cardiovascular disease, and chronic kidney disease (CKD). Beverley outlines how nursing roles in general practice have evolved from task-based activities to autonomous, multidisciplinary management of patients with multimorbidity.

The conversation focuses on the practical delivery of CKD care in primary care settings. Key areas include how CKD is explained to patients, the importance of recognising CKD as a marker of increased cardiovascular risk, and the role of urine albumin–creatinine ratio (ACR) testing alongside estimated glomerular filtration rate (eGFR) in risk stratification and prognosis. The episode also explores system-level factors influencing care, including incentivisation frameworks, team education, and strategies for improving the uptake of recommended monitoring and evidence-based interventions. The content is relevant to clinicians involved in the care of patients with diabetes, hypertension, cardiovascular disease, and CKD across both primary and 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)

Top 3 Takeaways

1. Primary care nurses play a central role in CKD management
Nursing roles in general practice have developed to include autonomous assessment and long-term management of patients with CKD and related cardiometabolic conditions, working within multidisciplinary teams.

2. CKD should be understood and communicated as a cardiovascular risk condition
Effective patient education focuses on cardiovascular risk reduction alongside kidney monitoring, helping to align treatment decisions with long-term outcomes.

3. Urine ACR testing is essential for risk stratification in CKD
Measurement of urine ACR, in combination with eGFR, provides critical information on kidney disease progression and cardiovascular risk and requires consistent implementation in primary care systems.

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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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 For Kidneys’ Sake, Prof Jeremy Levy and Dr Andrew Frankel are joined by heart failure specialist: Carys Barton, Consultant Heart Failure Nurse and the first nurse to chair the British Society for Heart Failure. Together they unpack what heart failure nurses actually do, why they’re the “glue” in a complex system, and how they navigate the tricky intersection between heart failure and chronic kidney disease, from acute and community services to virtual care and palliative support.

They explore HFpEF, HFrEF and 'mildly reduced' EF, potassium panic, diuretics wrongly labelled 'nephrotoxic', and the art of accepting creatinine rises without reaching for the stop button. Carys is unapologetically pragmatic, championing rapid optimisation, potassium binders over drug withdrawal, and educating patients and families as the true game-changer. If you look after patients with heart failure, CKD, or both, this is 25 minutes of high-yield insight. Tune in and share it with your cardiology, renal and primary care colleagues.

 Top 5 Takeaways

1. Heart failure nurses provide essential continuity: linking hospital, community and primary care.
2. HFpEF matters: half of patients have it, yet many services still don’t see them.
3. Creatinine rises are expected: look for trends and new baselines, not panic points.
4. Potassium needs context: don’t stop life-saving meds for a single reading over
5. Rapid optimisation works: starting all four pillars early is safe, even 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.

You can also join the community by signing up to our newsletter here

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

Do you have a question? Send it now...

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 and Andrew revisit one of the most fundamental yet persistently misunderstood areas in kidney care: the use and misuse of renin–angiotensin system inhibitors (RAASIs). Despite being cheap, powerful, and backed by decades of evidence, these cornerstone drugs remain under-dosed, frequently interrupted, and poorly optimised in real-world practice. The hosts examine why so many patients remain on subtherapeutic doses, how unnecessary caution and slow titration in primary care can blunt benefits, and why maximal dosing matters far more than blood pressure alone.

They then take listeners through the “patient journey” of being on a RAASI, exploring predictable bumps in the road, especially hyperkalemia and how proactive preparation could prevent the all-too-common cycle of unnecessary emergency visits and abrupt drug cessation. They unpack practical strategies: identifying high-risk patients, simple steps to minimise potassium rises, the role of constipation and diet, and the increasingly important place of modern potassium binders. Ultimately, Jeremy and Andrew make a compelling case: RAASIs only work when the patient actually stays on them, and with the right approach, nearly every patient can.

Top 5 Takeaways

1️⃣ Maximal doses matter — Subtherapeutic RAASI dosing is common, but full doses offer far greater cardio-renal protection than BP reductions alone.
2️⃣ Titrate faster — safely — Most patients can start on higher doses (e.g., Ramipril 5 mg, not 1.25 mg). Slow, cautious uptitration often delays benefits.
3️⃣ Hyperkalemia is predictable, not surprising — It’s a physiologic effect of RAAS blockade, not an adverse event. High-risk patients can be anticipated.
4️⃣ Prepare patients for the journey — Early education on potassium, diet, constipation, and reversible triggers prevents unnecessary drug interruption.
5️⃣ Don’t stop RAASIs too quickly — Most potassium rises are fixable; newer potassium binders allow continued, safe use of ACEi/ARB therapy.

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)

CaReMe UK - British Cardiovascular Society

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.

You can also join the community by signing up to our newsletter here

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