Chronic Kidney Disease (including SGLT2 inhibitors)
Chronic Kidney Disease (CKD) is a public health emergency. By 2033, the number of people with CKD stages 3-5 is projected to reach 3.9 million. It is driven by an ageing population, diabetes, hypertension, cardiovascular disease, and other important factors such as health and economic inequalities.
In the CaRe4Me Leeds project, we identified the need for accessible resources for both patients and clinicians. This webpage provides essential information about CKD as a condition and highlights the role of SGLT2 inhibitors in its management. Here, you will find valuable resources and guidance tailored for both clinicians and patients. We invite you to explore the sections to enhance your understanding and management of CKD.
Clinician Resources
New West Yorkshire guidance for the management of CKD includes diagnosing CKD, categorising, and monitoring CKD, when to refer to secondary care and the “4 Key Things in 4 Months to Save Lives” approach to medicines optimisation. It can be accessed here: West Yorkshire Guideline for the Management of Chronic kidney Disease (CKD) for Adults
National NICE guidance can also be accessed here: Chronic kidney disease: assessment and management
The Kidney Failure Risk Equation (KFRE) can be used to risk stratify patients for the progression to end-stage kidney disease, and we encourage its use at each review. The 5-year risk score helps assess the need for secondary care input, enabling timely and appropriate referrals.
The Leeds SGLT2 inhibitor guidance provides essential information for clinicians considering starting an SGLT2 inhibitor for patients. It includes important cautions and contraindications, key side effects to discuss, and appropriate dosing based on renal function for each indication (including heart failure, type 2 diabetes, and CKD). It can be accessed here: Leeds Citywide Guideline for the Safe and Appropriate Use of Sodium Glucose Co-Transporter 2 inhibitors (SGLT2 inhibitors)
SGLT2 inhibitors play an important role in CKD management, but clinicians must adopt a holistic, person-centred approach that considers polypharmacy, multimorbidity, and frailty. The Leeds guidance for Glycaemic Control for Older People with Type 2 Diabetes and Frailty and/or Multi-morbidity includes individualised HbA1c targets for patients with varying degrees of frailty, and considerations for prescribing.
Cardiovascular disease risk is elevated in individuals living with CKD; therefore, consideration should be given to the optimisation of lipid lowering therapies. Further guidance can be found in the Leeds Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD.
The above links can also be located in the Leeds ‘Chronic Kidney Disease’ template on EMIS and SystmOne.
Patient Resources
The CaRe4Me project emphasises the importance of involving patients in discussions about their CKD diagnosis, as many remain unaware of their diagnosis or the associated risks.
Here you can find resources tailored for patients to help them understand their CKD diagnosis and key considerations to note.
- Chronic kidney disease (CKD) | Kidney Care UK
- 10 healthy habits for happy kidneys | Kidney Care UK
- Potassium in Your CKD Diet | National Kidney Foundation
West Yorkshire ICB has acquired a license to Cognitant Kidney Essentials resources for 12 months. Kidney Essentials is a web based educational resource for people who wish to know more about chronic kidney disease (CKD), how it is managed and what to expect if you have the condition. The resources are available to be sent to patients in 6 different languages which are culturally sensitive and can be accessed here: www.healthinote.com/ckd-wyk
SGLT2 Inhibitor Resources for Patients
The Leeds Information for People on SGLT-2 Inhibitors patient information leaflet covers all indications, including heart failure, type 2 diabetes, and chronic kidney disease. It can be sent digitally or downloaded and printed: Information for People on SGLT-2 inhibitors
An easy read format can also be accessed here: My ‘gliflozin’ medication
It is important sick day rules are discussed with patients: Sick Day Medication Guidance in Chronic Kidney Disease
SGLT2 inhibitor brand-specific patient information is also available:
Dapagliflozin (Forxiga):
- Your Guide To Forxiga® (Dapagliflozin) In Chronic Kidney Disease (CKD) For Patients With Type 2 Diabetes
- Dapagliflozin patient information available to select in 9 different languages: myAZmed | Forxiga – Choose your Language
Empagliflozin (Jardiance)
Advanced Care: Finerenone
Finerenone is a non-steroidal mineralocorticoid receptor antagonist available for individuals living with CKD and Type 2 Diabetes who are optimised on standard care (RAAS blockade and SGLT2 inhibitor).
For eligibility criteria, please refer to the West Yorkshire CKD guidance, and for details on prescribing finerenone in West Yorkshire, consult the local shared care guidance: