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)

This episode is a refreshed re-release of “Sweet Urine – Good Times Never Seemed So Good”, one of our early For Kidneys Sake podcasts, revisited to reflect how quickly the evidence base around SGLT2 inhibitors has evolved. Originally developed as glucose-lowering therapies, drugs such as dapagliflozin, empagliflozin and canagliflozin are now firmly established as powerful cardiorenal protective agents. Since the first release, further studies have strengthened the evidence that these medications slow progression of chronic kidney disease (CKD), reduce heart failure events, and improve survival, even in people without diabetes.

Updated NICE guidance now places SGLT2 inhibitors alongside metformin as foundational therapy in type 2 diabetes, marking a major shift in clinical practice.

In this episode, we revisit who should receive SGLT2 inhibitors, how to start them safely, and how to manage common concerns in primary care. The discussion reinforces that these drugs should be considered in patients with CKD, heart failure, and diabetes, often irrespective of albuminuria or diabetic status. Practical prescribing advice remains unchanged: select patients carefully (particularly excluding those at risk of ketoacidosis), give clear sick day guidance, and be aware of manageable side effects such as genital fungal infections. Overall, this refreshed episode highlights just how central SGLT2 inhibitors have become in modern kidney and cardiovascular care, and why clinicians should feel confident using them.

Top Take aways:

This is a refreshed episode: A re-release of one of our early podcasts, now updated with stronger evidence and evolving guidance on SGLT2 inhibitors.

Think beyond diabetes: SGLT2 inhibitors are now key cardiorenal drugs—protecting kidneys and reducing heart failure and mortality, even in people without diabetes.

Use them early and widely: Indicated in CKD, heart failure (any ejection fraction), and type 2 diabetes—often regardless of albuminuria.

Safe to start with simple rules: Avoid in type 1 diabetes or high DKA risk, give sick day guidance, and adjust insulin/sulfonylureas if needed.

Big benefits, small risks: Side effects are usually mild and manageable, while benefits in slowing CKD progression and reducing cardiovascular events are substantial.

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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