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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 episode of For Kidneys’ Sake, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel are joined by Rory Donnelly, a senior pharmacist and system lead for diabetes and chronic kidney disease (CKD) in Hammersmith and Fulham. They discuss the expanding role of pharmacists in the management of CKD and the wider cardio-renal-metabolic (CRM) spectrum in primary care. Rory explains how pharmacists identify and review patients with CKD, optimise medicines, and provide education to support better self-management, while working closely with GPs and nursing colleagues.

The conversation covers practical challenges such as confirming a CKD diagnosis, interpreting changes in kidney function after starting treatment, and deciding when to adjust therapy for frail or elderly patients. The discussion also highlights newer treatments such as SGLT2 inhibitors and finerenone, and the ongoing importance of lifestyle advice and clear communication. The episode provides practical, evidence-based insights for pharmacists and clinicians supporting people with kidney and metabolic conditions in primary care.

Key Takeaways

1. Pharmacists are central to CKD and CRM management – They lead medicine reviews, coding, and patient education within long-term condition care.
2. Confirm CKD before diagnosis – Use previous results and trends in eGFR and ACR to ensure it is chronic and not an acute or temporary change.
3. Individualise treatment – Clinical judgement should take priority over rigid guideline use, particularly for older or frail patients.
4. Understand expected treatment effects – A modest fall in eGFR after starting ACE inhibitors, SGLT2 inhibitors, or finerenone is expected; monitor rather than stop treatment unnecessarily.
5. Support lifestyle and self-care – Encourage healthy diet, regular exercise, and patient understanding that CKD monitoring aims to protect long-term kidney health.

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, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel speak with Dr. Madhvi Joshi, a GP and certified health coach, about the power of personalised care and health coaching in managing chronic conditions such as kidney, heart, and metabolic diseases. Dr. Joshi explains how shifting from a directive approach (“what’s the matter with you”) to a collaborative one (“what matters to you”) helps unlock patient motivation, improve adherence, and build more meaningful partnerships. She discusses how understanding patients’ life contexts, values, and readiness for change can transform both outcomes and satisfaction for patients and clinicians alike.

Dr Joshi highlights practical frameworks such as the GROW model (Goals, Reality, Options, Will Do) and the 5As of behaviour change (Assess, Advise, Agree, Assist, Arrange) to guide conversations. She also shares a compelling case study demonstrating how lifestyle adjustments, compassionate dialogue, and shared goal setting led to significant improvements in health and well-being for a patient with multiple cardio-renal-metabolic risk factors. The discussion underscores that true progress comes from empowering patients as active participants, helping them navigate their health journeys with curiosity, empathy, and hope.

Key Takeaways

1. Personalised Care – Focus on What Matters to the Person

Shift from a disease-focused to a person-focused approach by asking, “What matters to you?” instead of “What’s the matter with you?”. This means seeing beyond clinical data to understand the patient’s life, values, and priorities. When people feel heard and understood, engagement and adherence naturally improve.

2. Coaching Mindset – Be Curious, Compassionate, and Non-Judgmental

Adopt a collaborative mindset rather than a directive one. Use curiosity to explore readiness for change, compassion to recognise challenges, and non-judgment to create trust. Coaching helps patients find their own solutions and apply knowledge in a way that fits their lives — turning advice into sustainable action

3. Structured Tools – Use GROW and 5As for Lasting Change.

Practical frameworks like GROW (Goals, Reality, Options, Will Do) and 5As (Assess, Advise, Agree, Assist, Arrange) guide conversations and support realistic goal-setting. They help clinicians and patients co-create clear, achievable steps — moving from one-off advice to measurable, lasting behaviour change.

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, consultants Prof Jeremy Levy and Dr Andrew Frankel are joined by Dr Melanie Dani, a geriatrician, to discuss the complexities of managing chronic kidney disease (CKD) in older adults. They highlight the importance of distinguishing between chronological age and frailty, two overlapping but distinct concepts that significantly influence clinical decision-making. The conversation explores how kidney function naturally declines with age, and raises the critical question of when this becomes a pathological concern requiring medical intervention.

Dr Dani stresses the value of personalised care, reminding listeners that older adults are not a homogenous group. Whether someone is a fit 85-year-old playing tennis or a frail resident in a care home, their values, priorities and tolerance for medical treatment will differ. The episode encourages shared decision-making, consideration of overall health context, and careful use of medications like ACE inhibitors and SGLT2 inhibitors based on likely benefits and side effects, rather than age alone.

Three Key Takeaways

1. Ageing vs Frailty: Frailty is a better predictor of health outcomes than age alone. It’s essential to assess a patient’s overall vulnerability and resilience when managing CKD.
2. Reduced GFR in Older Adults: A declining GFR may reflect normal ageing rather than disease, but it still carries risks, particularly cardiovascular. Management should be tailored to the individual, not solely guided by guidelines.
3. Personalised, Contextualised Care: Decisions about referral, investigation and treatment must consider the whole person—their wishes, comorbidities, and quality of life—rather than focusing only on kidney function metrics.

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 

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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).

Welcome to For Kidneys’ Sake! The new name for our podcast series is previously known as The Rest Is Kidneys. In this first episode of our new 20-part series, Prof Jeremy Levy and Dr Andrew Frankel return to tackle a topic that crops up frequently in both clinic and primary care: supplements, herbal remedies, and recreational drugs and what they really mean for people with chronic kidney disease (CKD).

This episode explores everything from high-dose vitamins and gym-related creatine use to the dangers of anabolic steroids, ketamine, and certain traditional herbal medicines. With their usual clarity and clinical insight, Jeremy and Andrew offer practical advice for clinicians and thoughtful guidance on how to approach these often-overlooked areas of patient care.

Key Takeaways:

1. Ask directly about supplements, herbs, and non-prescribed products – especially in anyone with reduced kidney function or a CKD diagnosis. These are often missed unless specifically asked about.
2. Standard multivitamins are safe in CKD, but high-dose vitamin C and extra vitamin D can be harmful, especially when kidney function is already reduced.
3. Creatine, high-protein diets, and muscle mass can raise creatinine without indicating CKD. Use a urine dipstick, ACR, blood pressure, and ultrasound to assess properly.
4. Anabolic steroids and ketamine carry serious risks, including nephrotic syndrome and irreversible bladder damage. These are increasingly common but poorly understood dangers.
5. Herbal remedies are not without harm – some are directly nephrotoxic, others interact with prescribed treatments. These should be avoided in CKD, but conversations must be handled with care and cultural awareness.

This opening discussion sets the tone for the series: practical, collaborative, and focused on bridging gaps between clinical insight and everyday patient care. Supplements and herbal products are everywhere, and understanding their impact is more important than ever for improving kidney health.

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 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)

Following the success of The Rest Is Kidneys, our podcast returns with a new name and a fresh series of conversations that get to the heart of kidney care. Hosted by Professor Jeremy Levy and Dr Andrew Frankel, For Kidneys Sake continues to bring primary and secondary care closer together through practical, down-to-earth discussions that inform, connect, and occasionally entertain. 

In Series 2, we'll be exploring and discussing 20 new topics – from CKD supplements and elderly care to fertility, early detection, and the evolving world of cardio-renal-metabolic care. Whether you’re a clinician, a patient, or simply curious, these bite-sized episodes offer insights you can use – with clarity, warmth and the odd kidney pun thrown in. 

We hope you enjoy listening.

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 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.

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 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.

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 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.

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, 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.

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 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.

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 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.

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, 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.

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, Dr Andrew Frankel and Prof Jeremy Levy are joined by Dr Tony Willis, a GP and clinical lead in diabetes and chronic kidney disease prevention. Together, they examine the evidence supporting the role of physical activity in enhancing outcomes for individuals with cardio-renal metabolic disease. Dr Willis shares findings from large-scale studies, including one involving over 120,000 participants, which showed that increased cardiorespiratory fitness is linked to significantly lower mortality. He highlights that the greatest health gains come from simply moving out of the least active group.

The conversation also covers the physiological effects of exercise, including improved blood glucose control, reduced inflammation, and the preservation of muscle mass, as well as the slowing of frailty. Dr Willis outlines practical advice for recommending physical activity, emphasising that both aerobic and resistance exercises are important and can be done without a gym. He also discusses behavioural techniques that support long-term change, helping clinicians guide patients to build sustainable, active routines.

Key Takeaways:

• Modest increases in activity yield significant health benefits, even in high-risk groups.
• Exercise is safe and beneficial at any age, with no known upper limit to its positive effects.
• Combining aerobic and resistance exercises offers the greatest physiological benefit.
• Simple behaviour change strategies, such as habit stacking, make new routines more sustainable.
• Clinicians should use motivational conversations rather than directives to encourage change.

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 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.

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...

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.

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...

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.

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 

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

Introducing For Kidneys' Sake podcast, a new series hosted by Consultant Nephrologists at Imperial College Healthcare NHS Trust, Mr Andrew Frankel and Prof Jeremy Levy. 

In this trailer, clinical lead nurse Joana Teles, local GP, and ICB clinical lead for cardiovascular and renal disease Kuldir Johal discuss why this podcast has been created. The series is designed to bring healthcare professionals, especially those in primary care, the latest updates and insights into kidney health management.

Over the years, the North West London Kidney Care team, consisting of nephrologists, kidney nurse specialists, and GPs, has worked closely to improve the integration of kidney care across primary and secondary services. Now, with this podcast, the aim is to share the knowledge and experience we've gathered to support clinicians in their everyday practice.

Each episode features concise, 15-minute discussions on important topics such as the diagnosis and management of chronic kidney disease (CKD), hyperkalaemia, heart failure, and practical tips for applying local CKD guidelines. The series also highlights innovative services like the Kidney Virtual Clinic and recent improvements in funding and awareness for kidney health.

Whether you’re catching up on your commute, during a coffee break, or while out for a walk, the North West London Kidney Care podcast is a convenient way to stay informed. With contributions from experts like Prof Jeremy Levy and Prof Andrew Frankel, along with special guest appearances, each episode is packed with valuable insights to help you better manage kidney health for your patients.

We hope you enjoy listening.

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, Dr Andrew Frankel and Prof Jeremy Levy are joined by Dr Khuldir Johal, a GP and clinical lead for the Harrow CRM Hub, to discuss the relationship between obesity and Cardio-Renal Metabolic (CRM) disease. Together, they examine how excess adipose tissue, particularly around the abdomen, can create a pro-inflammatory state that contributes to vascular and organ damage, influencing the development of heart, kidney, and metabolic disorders. The episode emphasises the need to move beyond managing diabetes, hypertension, and kidney disease as separate conditions, and instead adopt a joined-up, clinically integrated approach.

Dr Johal outlines how the Harrow CRM Hub identifies at-risk patients early, using indicators such as raised BMI and type 2 diabetes, then supports them through a longer consultation model, tailored advice, and multidisciplinary care. The focus is on empowering patients to understand and manage their own health through regular monitoring and education, rather than relying solely on medication. The episode concludes with a call for clinicians to recognise the interrelated nature of CRM conditions and intervene as early as possible to reduce the long-term burden on patients and the health system.

Key Takeaways

1. CRM disease is interconnected – Heart, kidney, and metabolic conditions share causes like obesity and inflammation and should be managed together, not in silos.
2. Obesity drives disease – Abdominal fat acts as an inflammatory organ, damaging vessels and accelerating heart and kidney problems.
3. Early detection can reverse risk – Identifying people early and supporting lifestyle change can slow or even reverse progression.
4. Holistic, team-based care works – Longer, integrated consultations involving GPs, coaches, and nutritionists empower patients and improve outcomes.
5. Empower patients – Give people access to their data and help them set realistic goals so they can take ownership of their health.

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)

Cardiovascular-Kidney-Metabolic Health: A Presidential Advisory From the American Heart Association | Circulation

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 special introductory episode of For Kidneys’ Sake, nephrologists Prof Jeremy Levy and Dr Andrew Frankel open a new series on Cardio-Renal Metabolic (CRM) disease, a complex syndrome where kidney disease, cardiovascular disease, and metabolic dysfunction intertwine. With obesity, diabetes, and hypertension on the rise, CRM is becoming a leading cause of kidney disease and an urgent challenge for integrated care delivery.

The conversation touches on how albuminuria and declining GFR are early signs of vascular damage, even in asymptomatic patients, and why abdominal fat is now viewed as metabolically active tissue that contributes to systemic inflammation. Jeremy and Andrew call for a shift from specialist-led care to a patient-focused model that unifies treatment strategies across kidney, heart, and metabolic health. This episode sets the stage for an enlightening series aimed at primary care clinicians and healthcare teams working with complex, multimorbid patients.

Key Takeaways: 

1. Cardio-Renal Metabolic (CRM) disease represents a unified condition, not just overlapping risk factors. 

2. Obesity-driven inflammation is a major contributor to both CKD and cardiovascular damage. 

3. Albuminuria and mild GFR decline often signal early systemic disease — even without symptoms. 

4. Healthcare must shift from fragmented, specialty-based care to integrated, patient-centric pathways. 5. Early intervention, education, and service redesign are key to managing CRM effectively.

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, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel discuss the relationship between gout and chronic kidney disease (CKD). They explore how CKD increases the risk of developing gout due to impaired uric acid excretion and sometimes the effects of commonly prescribed medications such as diuretics. The conversation demystifies the clinical presentation of gout in CKD patients and clarifies that the diagnosis remains unchanged; it’s typically a clinical judgement, supported by elevated uric acid levels.

Most importantly, the episode offers a detailed and practical discussion on managing acute gout attacks in CKD patients, covering the nuanced use of NSAIDs, colchicine, and steroids depending on the severity of kidney impairment. The hosts also stress the importance of lifestyle modifications, including dietary changes and exercise, as well as when and how to initiate preventative treatments like allopurinol or febuxostat. With a tone that balances clinical depth and approachability, Jeremy and Andrew provide valuable guidance for GPs, pharmacists, and healthcare professionals managing these intersecting conditions.

Key Takeaways: 

1. Gout is more common in people with CKD due to reduced uric acid excretion and side effects of common medications. 

2. Diagnosis of gout in CKD patients remains clinical and mirrors that in the general population. 

3. NSAIDs can be used cautiously in early CKD (GFR >45) for short durations, but not repeatedly; colchicine and steroids are alternatives, and for more advanced stages of CKD. 

4. Lifestyle changes – especially diet and exercise – play a vital role in reducing gout attacks. 

5. Allopurinol should be started at 100mg in CKD and titrated based on uric acid levels, with febuxostat as a second-line option.

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 podcast, consultant nephrologists Jeremy Levy and Andrew Frankel are joined by Dr. Mohammad Haidar, a GP and clinical lead for cardiovascular and renal medicine in North West London. They discuss how to interpret eGFR (estimated glomerular filtration rate) results, particularly when values fall between 60 and 90, a range often misunderstood in primary care. The conversation highlights that while this range can indicate early chronic kidney disease (CKD) when combined with other abnormalities (e.g., proteinuria or abnormal ultrasound findings), an isolated eGFR of 60–90—especially in older adults, may simply reflect normal age-related decline in kidney function rather than a pathological condition.

The discussion emphasises the importance of context when interpreting eGFR results and advising repeating tests to account for natural fluctuations, assessing urinary abnormalities, blood pressure, and family history, and avoiding unnecessary labelling of patients with CKD when no other risk factors are present. They also address the practical challenges for primary care teams, such as patient anxiety over flagged “abnormal” lab results, and the need for clear communication and appropriate follow-up.

Three main takeaways:

1.      An eGFR of 60–90 does not necessarily indicate CKD—context, age, and additional markers like proteinuria are crucial in determining risk.

2.      Repeat testing and urine analysis are key steps in distinguishing between true kidney issues and normal variations or age-related decline.

3.      Patient reassurance and appropriate monitoring (e.g., annual or biannual reviews) are essential, while avoiding unnecessary investigations or alarming terminology when kidney function is stable and otherwise healthy.

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...

In this episode of For Kidney’s Sake, consultant nephrologists Jeremy Levy and Andrew Frankel discuss albuminuria, focusing on the interpretation and management of low-level abnormal results. They explore how to distinguish between harmless fluctuations and early signs of kidney damage, clarify the coding system (A1, A2, A3), and explain why urine albumin-to-creatinine ratio (ACR) is such a valuable tool for early detection of kidney issues.

The conversation provides practical guidance for primary care teams, including when to repeat tests, when to refer, and how to reassure patients who are worried about ‘abnormal’ flagged results. They also emphasise the importance of annual kidney health checks for those at risk, especially patients with diabetes, hypertension, cardiovascular disease, or a family history of kidney disease.

3 Key Takeaways:

1. Know the ACR thresholds:
    
   • A1: <3 mg/mmol (normal) 
   • A2: 3–30 mg/mmol (moderately increased 
   • A3: >30 mg/mmol (severely increased, needs action).
     Severe proteinuria (>300 mg/mmol) requires urgent management.
2. Repeat and confirm abnormal results:
   Low-level abnormal ACRs (e.g., 5–20 mg/mmol) should be repeated to rule out temporary factors like exercise or fever. Persistent abnormal ACR—even with a normal eGFR—signals early kidney or vascular damage.
3. Manage risks early:
   Abnormal ACR requires blood pressure control (<130/80), consideration of ACE inhibitors/ARBs and SGLT2 inhibitors (especially in diabetes), and annual kidney health checks. Early optimisation can reverse or reduce albuminuria.

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 discussion, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel are joined by Dr Phil Webster to examine fertility and pregnancy in the context of chronic kidney disease (CKD). They highlight that while many CKD patients are older, a significant number of younger individuals, especially those with inherited or congenital kidney conditions, will face issues related to fertility and pregnancy. CKD affects approximately 3% of pregnancies, and the severity of kidney disease directly influences fertility and pregnancy outcomes.

The conversation is structured into three key areas: fertility in men and women with CKD, pre-pregnancy counselling for women with CKD, and management during pregnancy. They emphasise that fertility is usually preserved in mild CKD but may decline with worsening kidney function. All women with CKD considering pregnancy should receive pre-pregnancy counselling to review medications, optimise blood pressure, and understand potential risks such as pre-eclampsia and accelerated kidney function decline. During pregnancy, specialist monitoring is essential. Women with CKD should ideally be managed through multidisciplinary maternal medicine networks, and contraceptive advice should be part of routine nephrology care.

Key Takeaways:

1. Fertility is generally unaffected in early CKD but declines as kidney function worsens; both men and women with advanced CKD may require specialist input.
2. Women with CKD should receive pre-pregnancy counselling to adjust medications, optimise kidney and blood pressure control, and assess risks, particularly of pre-eclampsia and kidney function loss.
3. Pregnancy in CKD requires enhanced monitoring through specialist clinics, with coordinated care across nephrology and obstetrics to ensure maternal and fetal health.

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, consultants Prof Jeremy Levy and Dr Andrew Frankel, both nephrologists at Imperial College Healthcare NHS Trust, discuss the significance and management of microscopic (non-visible) haematuria in primary care. They provide practical guidance for general practitioners on how to interpret urine dipstick findings, the appropriate steps for investigation, and when specialist referral is warranted. The conversation emphasises the importance of not overlooking persistent haematuria, while also acknowledging the challenges in balancing appropriate concern with unnecessary anxiety or over-referral.

The clinicians explore differential diagnoses, such as glomerulonephritis, IgA nephropathy, and hereditary conditions like thin basement membrane disorder or Alport syndrome. They stress the role of imaging, the presence of proteinuria, and age-based referral pathways in forming a management plan. A key theme is the long-term follow-up of patients with isolated haematuria, even when kidney function is normal, to monitor for progression via regular kidney health checks in primary care. The discussion is informative and grounded in real-world experience, aiming to clarify an area that is often perceived as ambiguous in general practice.

Three Main Takeaways:

1. Persistent microscopic haematuria warrants investigation and should not be dismissed, particularly when confirmed on repeat testing and associated with other findings such as proteinuria.
2. All patients with confirmed haematuria should undergo a renal ultrasound, and referral decisions should be guided by age and associated symptoms or findings. Generally, referrals are made to urology if the patient is over 50, and to nephrology if the patient is under 50 or if proteinuria is present.
3. Even when no serious underlying condition is identified, patients with isolated haematuria require annual monitoring, including blood pressure, kidney function (GFR), and urine albumin-to-creatinine ratio, ideally recorded in primary care records to ensure lifelong follow-up.

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 discuss one of the most deceptively tricky areas of everyday kidney and general medical practice: assessing fluid balance. From swollen ankles to dizzy spells, from SGLT2-induced polyuria to the eternal mystery of the JVP, our hosts unpack why no single test ever gives “the answer” and why clinical acumen still matters. They explore how to distinguish true fluid overload from ankle oedema caused by amlodipine, when weight matters, and why blood urea creatinine ratios can occasionally point you in the right direction.

They also highlight the subtleties of recognising volume depletion, why 'dehydration' is often the wrong term, and how sick-day rules, medications, polyuria, and patient education all intersect in real life. From emerging technologies like smartphone perfusion video analysis to the humble power of a daily weigh-in, this conversation offers practical wisdom and a forward-looking perspective, a must-listen for anyone navigating the art and science of keeping patients neither too wet nor too dry.

Top 5 Takeaways

1. There’s no single test for fluid balance — Clinical assessment remains king: history, examination, serial weights, blood pressure (including postural changes), and context are indispensable.
2. Not all ankle swelling is fluid overload — Calcium channel blockers frequently cause ankle oedema that doesn’t require diuretics. Always consider medication effects before treating fluid overload.
3. Volume depletion is often subtle — Thirst, dizziness, polyuria (especially in CKD or after starting SGLT2 inhibitors), and weight loss are key clues, but each has confounders.
4. Simple tools beat fancy tech (for now) — Trends in weight, postural blood pressure, and blood urea/creatinine ratio often outperform bioimpedance machines or wearables in real-world clinical value.
5. Prepare patients with sick day guidance — Clear, proactive advice about temporarily holding RAS blockers, diuretics, or SGLT2 inhibitors during vomiting/diarrhoea prevents avoidable AKI.

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)

Pumping Marvellous | The UK's Heart Failure Charity

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 

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 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)

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)

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)

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)

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)

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.

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)

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.

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)

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:
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 reflective re-release episode, Dr Andrew Frankel and Prof Jeremy Levy revisit one of the podcast’s most practical and enduring topics: low-level albuminuria and the interpretation of urine ACR testing in primary care. As the podcast prepares for a new series, the team looks back on the importance of recognising albuminuria as an early marker of both kidney and cardiovascular disease, and why confident interpretation of these results remains essential for clinicians managing patients with CKD risk factors. 

Andrew and Jeremy reflect on the clinical uncertainty that can arise from mildly abnormal ACR results and offer reassuring, pragmatic guidance on what these numbers really mean. They revisit the A1–A3 categories, discuss when repeat testing is appropriate, explain the difference between ACR and PCR, and emphasise that low-level abnormalities are rarely an emergency. The episode also highlights how albuminuria can be present even when eGFR remains normal, reinforcing the value of early testing and longitudinal monitoring in primary care. 

5 Key Takeaways

1.  Albuminuria remains an important early marker of kidney and cardiovascular disease risk. 
2.  Mildly raised ACR results should usually be repeated before making long-term clinical decisions. 
3.  Nephrotic-range proteinuria is typically far higher than the low-level abnormalities commonly seen in primary care. 
4.  Patients can have a normal eGFR while still showing early kidney damage through an abnormal ACR. 
5.  A practical, consistent approach to ACR testing helps support earlier identification and better management of CKD risk.

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 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.

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