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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 refreshed re-release episode, Professor Jeremy Levy and Dr Andrew Frankel revisit one of the most common and challenging areas in chronic kidney disease (CKD) management: medication reviews and safe prescribing. 

They discuss how to approach prescribing decisions as kidney function declines, including the practical use of eGFR over creatinine clearance, how to identify medications that need dose adjustment or review, and the importance of “Sick Day” guidance during intercurrent illness. The episode also tackles common misconceptions around so-called “nephrotoxic” drugs and explains why many beneficial medications can often be continued safely with careful monitoring.

The second half of the episode focuses on pain management in CKD — a topic that frequently causes uncertainty in primary care. Jeremy and Andrew outline which analgesics can be used safely, which should generally be avoided, and how to prescribe cautiously using the principle of “start low and go slow.” They cover the safe use of paracetamol, tramadol, oxycodone, fentanyl and neuropathic pain agents, while reinforcing why regular NSAIDs and morphine are usually poor choices in patients with impaired kidney function. A highly practical refresher packed with prescribing tips for clinicians managing CKD in everyday practice.

5 Key Takeaways

• Use eGFR pragmatically for prescribing decisions in CKD rather than worrying excessively about creatinine clearance calculations.
• Regular NSAID use should generally be avoided in CKD, although very short courses may be acceptable in selected patients.
• Metformin is usually safe down to an eGFR of 30, with dose reduction recommended below 45 and good Sick Day guidance essential.
• Safe analgesic options in CKD include paracetamol, low-dose tramadol, oxycodone and fentanyl — but morphine should usually be avoided.
• “Start low and go slow” is the key principle when prescribing many medications, especially analgesics, in people with 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.

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