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 series aims to provide healthcare professionals, particularly primary care professionals, with accessible insights into kidney health.  Each episode offers bite-sized discussions on key topics such as chronic kidney disease management and heart failure and practical updates for improving patient care. With episodes just 15 minutes long, you can listen on your commute, during a break, or while out for a walk. Join us as we explore the latest advancements and strategies in integrated kidney care to empower clinicians and patients alike.

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For Kidneys Sake

North West London Kidney Care

If the urine ACR improves, for example, from 50 to 20, should the A code be changed from A3 to A2? Yes or no, and why?

What about the very elderly or frail?

– In people with CKD, are we definitely saying no to NSAIDs?

The BNF states that Ramipril shouldn’t be increased above 5 mg/day if eGFR is lower than 30. Our local guidelines advise maximal rapid RAASi dosing, including Ramipril 10 mg for all levels of eGFR. Should people be switched to a different agent? Should th

NICE only recommends RAASi therapy if the ACR is greater than 30 in the absence of diabetes. Is there any context in which you would initiate this sooner?

A 40-year-old patient has an eGFR greater than 90 and a urinary ACR consistently between 10-20 (CKD stage G1A2, without diabetes). What should primary care colleagues do—code and monitor yearly, or something else?

Would you say that SGLT2 inhibitors have been the major landmark in CKD management in your careers?

Is there a risk of hypoglycemia with SGLT2 inhibitors, and how do we minimise this risk in people without type 2 diabetes?

Should we stop SGLT2 inhibitors after a single UTI episode or after genital thrush?

There are concerns in primary care that the requirement to provide written warnings about Fournier’s gangrene becomes a barrier to SGLT2 prescribing. Have you ever seen Fournier’s gangrene, and what are your recommendations?

Does increased urine output from SGLT2 inhibitors lead to a significant risk of dehydration or hyperkalaemia?

Furosemide increases creatinine and reduces eGFR. Should it be avoided in CKD? Should the dose be reduced or stopped if eGFR declines? Can we increase the dose if peripheral or pulmonary edema worsens?

What should be done when a patient’s serum potassium is between 5.5 and 5.8 after treatment optimisation? Should RAASi therapy be reduced?

Is it possible to manage CKD with lifestyle changes alone?

CKD Essentials: Your Top Questions Answered