Diet

Diet, and salt intake in particular, is likely to come up in discussions with patients about kidney health. There is no specific advice about diet or salt intake for patients with kidney disease. However, the general advice of reducing salt intake €“ as for all patients with hypertension and cardiovascular disease €“ is appropriate. It is worth noting that all reduced sodium salts have a high potassium content so is not suitable for patients with kidney disease, who tend to accumulate potassium even when on a low potassium diet. Following a healthy lifestyle of regular exercise, not smoking and having a balanced diet are also important for kidney health and should be recommended to patients.

'Sick day rules'

This is a strategy to help prevent acute kidney injury. The sick day rules recommend that some medicines that have the potential to impair renal function and contribute to the development of acute kidney injury are temporarily withheld when a vulnerable patient develops illnesses such as diarrhoea, vomiting, fever or infection. The drugs to be considered include ACE inhibitors, ARBs, diuretics and NSAIDs.

The recommendation in the National Institute for Health and Care Excellence (NICE) acute kidney guideline (CG169) is to €consider temporarily stopping ACE inhibitors and ARBs in adults, children and young people with diarrhoea, vomiting or sepsis until their clinical condition has improved and stabilised€. There are concerns that withholding medicines may be detrimental in some cases and this has raised a question mark over the widespread implementation of sick day rules advice.

A systematic review of the published evidence is underway. Until this review is completed, the current position is that clinicians should provide sick day rules guidance on temporary cessation of medicines to people deemed at high risk of acute kidney injury, based on an individual risk assessment. Pharmacy teams should communicate the risks of acute kidney injury to patients with vomiting or diarrhoea, fever sweats or shaking, in whom they have noted a number of risk factors or triggers.

They should also offer guidance on hydration and advise withholding risky medicines for 24-48 hours, only until their acute illness is over. Pharmacy teams can also provide sick day rules leaflets to every person who could be at risk of developing acute kidney injury or is taking an ACE inhibitor or ARB.