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NSAID harm in chronic kidney disease — DGM MCQ

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ModeratePolypharmacyNSAID harm in chronic kidney diseaseDGM

An 83-year-old woman with osteoarthritis and chronic kidney disease stage 3b has ankle swelling and dyspepsia. She takes ibuprofen daily, lansoprazole, amlodipine, bendroflumethiazide and paracetamol. eGFR has fallen from 48 to 31 mL/min/1.73 m2 in 6 months. Which medication should be reviewed?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Ibuprofen

Regular NSAID use can worsen renal function, fluid retention and gastrointestinal risk in older adults, particularly with CKD and diuretics. Amlodipine may cause ankle swelling but does not explain the renal decline as well. STOPP criteria highlight NSAIDs as commonly inappropriate in older people with renal impairment or high bleeding risk.

Reference: STOPP/START criteria v3; BNF Prescribing in elderly