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NSAID Avoidance CKD Analgesia — ESENeph MCQ

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EasyChronic Kidney DiseaseNSAID Avoidance CKD AnalgesiaESENeph

A 50-year-old man with CKD G3b (eGFR 36 mL/min/1.73m2) needs analgesia for chronic lower back pain. He has been taking Ibuprofen 400 mg TDS regularly. Why is this problematic and what should replace it?

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Correct answer: B — Regular NSAIDs should be avoided in CKD due to risk of AKI, GI bleeding, fluid retention, and CKD progression; use Paracetamol first-line, consider short-course weak opioids if needed

Regular oral NSAID use in CKD accelerates CKD progression, increases AKI risk (especially with concurrent RASi and diuretics – 'triple whammy'), causes fluid retention and hypertension, and increases GI bleeding risk. NICE CG173 and KDIGO 2024 recommend Paracetamol as first-line analgesic in CKD. If stronger analgesia is needed, short courses of weak opioids (Codeine with dose adjustment, Tramadol with caution) can be considered. Topical NSAIDs have lower systemic absorption and may be safer for localised pain.

Reference: NICE CG173 2020 – Chronic Pain; KDIGO 2024 – CKD (Nephrotoxin Avoidance)