Why should NSAIDs be avoided in CKD patients?

• A. They have no effect
• B. They cause nephrotoxicity and can precipitate AKI
• C. They cure CKD
• D. They are recommended for CKD management

Answer: (B)

NSAIDs should be avoided because they directly threaten kidney function by blocking prostaglandin production. Prostaglandins help dilate the afferent arteriole in the kidney, preserving blood flow and filtration when perfusion is variable or reduced. In chronic kidney disease, the kidneys depend more on this prostaglandin-mediated dilation to maintain the glomerular filtration rate. When NSAIDs inhibit COX enzymes and reduce prostaglandins, the afferent arteriole constricts, renal blood flow drops, and GFR falls, which can trigger acute kidney injury or worsen CKD. They do not cure CKD or help its management, and their effect is not neutral, making them a poor choice for someone with compromised kidney function. Consider alternatives for pain management under medical guidance.