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CKD Essentials: Your Top Questions Answered
Manage episode 464873401 series 3602911
The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)
In this special Q&A episode, Prof Jeremy Levy, Dr Andrew Frankel, and specialist nurse Joana Teles tackle key CKD questions from primary care. They discuss CKD coding adjustments, NSAID safety, and the importance of optimising RAAS inhibitors and SGLT2 inhibitors. Practical guidance is given on prescribing, managing side effects, and using diuretics like furosemide effectively.
The hosts emphasise that while lifestyle changes are crucial, medication remains key to slowing CKD progression and reducing cardiovascular risk.
Take-Home Messages:
CKD Coding – Adjust ACR coding as values improve; coding helps with safe prescribing.
NSAIDs & CKD – Generally avoid, but occasional short-term use may be safe in mild CKD.
RAASi & SGLT2 Inhibitors – Maximise doses; SGLT2 inhibitors are transformative for CKD and heart failure.
Managing Risks – Address side effects proactively but don’t let concerns block treatment.
Diuretics & Fluid Balance – Furosemide isn’t nephrotoxic; use it to relieve symptoms.
Hyperkalaemia – Potassium up to 6 mmol/L is usually safe; use binders before stopping RAASi.
Lifestyle & Medications – Diet and exercise help, but medication is often essential.
Effective CKD management balances accurate coding, lifestyle changes, and optimised medication use. While lifestyle adjustments help, RAAS and SGLT2 inhibitors are key to slowing progression and reducing cardiovascular risk.
Primary care teams should confidently adjust treatment, manage side effects, and take a pragmatic approach to NSAIDs, diuretics, and hyperkalaemia. Proactive, evidence-based care ensures better long-term kidney health.
The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.
The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.
Produced by award-winning media and marketing specialist Heather Pownall of Heather's Media Hub
Chapters
1. CKD Essentials: Your Top Questions Answered (00:00:00)
2. 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? (00:02:57)
3. What about the very elderly or frail? (00:04:30)
4. – In people with CKD, are we definitely saying no to NSAIDs? (00:07:22)
5. 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 (00:11:25)
6. 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? (00:14:33)
7. 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? (00:17:54)
8. Would you say that SGLT2 inhibitors have been the major landmark in CKD management in your careers? (00:21:36)
9. Is there a risk of hypoglycemia with SGLT2 inhibitors, and how do we minimise this risk in people without type 2 diabetes? (00:25:11)
10. Should we stop SGLT2 inhibitors after a single UTI episode or after genital thrush? (00:27:15)
11. 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? (00:28:28)
12. Does increased urine output from SGLT2 inhibitors lead to a significant risk of dehydration or hyperkalaemia? (00:30:08)
13. 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? (00:32:09)
14. 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? (00:36:20)
15. Is it possible to manage CKD with lifestyle changes alone? (00:38:02)
12 episodes
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