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.

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