Which analgesic should be avoided or used with caution in CKD due to risk of renal impairment?

• A. Acetaminophen
• B. Nonsteroidal Anti-Inflammatory Drugs
• C. Gabapentin
• D. Topical Lidocaine

Answer: (B)

In CKD, choosing pain relief means avoiding meds that can worsen kidney function. Nonsteroidal anti-inflammatory drugs block prostaglandins that help keep kidney blood flow, so they can reduce renal perfusion and trigger acute kidney injury or accelerate CKD progression. Because of this risk, they should be avoided or used with extreme caution, typically only when other options are not suitable and with close monitoring and the lowest effective dose for the shortest time. Acetaminophen is generally safer in CKD at recommended doses, since it has little effect on renal blood flow. If neuropathic or chronic pain is involved, gabapentin requires renal dosing adjustments to prevent buildup. Topical lidocaine is usually safe due to minimal systemic absorption, though monitor for skin irritation or excessive absorption with large or damaged areas.