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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, 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

Send us a text

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

Send us a text

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