Prof Debasish Banerjee (St George's University Hospitals NHS Foundation Trust, London, UK) joins us to discuss the practical management of heart failure in patients with coexisting chronic kidney disease (CKD) and diabetes, and how to close the gap between guideline recommendations and everyday clinical practice.

In this interview, Prof Banerjee addresses one of the central challenges in cardio-renal-metabolic medicine: despite a robust evidence base supporting guideline-directed medical therapy (GDMT) in CKD, real-world uptake remains low, with only a minority of eligible patients receiving full quadruple therapy. He examines the barriers that drive this implementation gap, particularly the clinical inertia and uncertainty surrounding rising creatinine and potassium in primary care - as well as the case for educating the wider multidisciplinary team, including pharmacists, on when therapy can safely be continued.

Interview Questions:

1. When HF, CKD and diabetes coexist, how does that triad change your use of guideline therapies?
2. In advanced CKD, how do you balance HF optimisation against eGFR, potassium and blood pressure concerns?
3. Where do you see the biggest gap between HF–CKD guidelines and front-line reality?
4. How do you practically integrate SGLT2 inhibitors and, when appropriate, GLP-1 RAs in HF with CKD and diabetes?
5. What are your most effective strategies for maintaining RAAS/MRA therapy despite hyperkalaemia or renal deterioration?
6. What one or two "Monday morning" changes would you like colleagues to make when reviewing medications and labs in HF–CKD–diabetes patients?

Editors: Jordan Rance
Videographer: Oliver Miles, David Ben-Harosh
Support: This is an independent interview produced by Radcliffe Cardiology.