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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.

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