A 68-year-old man with a history of hypertension and mild chronic kidney disease (eGFR 50 mL/min/1.73m²) presents with moderate osteoarthritis of the knee. He requires long-term analgesia and anti-inflammatory therapy. Which NSAID is the preferred choice for this patient?

Explanation

## Rationale for Meloxicam in Renal Impairment **Key Point:** Meloxicam is a selective COX-2 inhibitor (preferential, not absolute) with a long half-life and is the preferred NSAID in patients with mild-to-moderate chronic kidney disease and hypertension. ### Why Meloxicam? 1. **Renal-Sparing Profile** - Meloxicam has minimal renal effects compared to non-selective NSAIDs - Preferential COX-2 inhibition reduces prostaglandin-mediated renal vasoconstriction - Safe at eGFR 30–60 mL/min/1.73m² with appropriate dosing 2. **Cardiovascular Safety** - Lower risk of fluid retention and blood pressure elevation than indomethacin or ibuprofen - Suitable for hypertensive patients 3. **Dosing in CKD** - Standard dose: 7.5–15 mg once daily (no dose adjustment needed for mild–moderate CKD) - Long half-life (~15–20 hours) allows once-daily dosing, improving compliance ### Comparison with Other NSAIDs | NSAID | Renal Effect | BP Effect | CKD Safety | Notes | |-------|--------------|-----------|-----------|-------| | **Meloxicam** | Minimal | Low | Safe (eGFR >30) | Preferred in CKD + HTN | | Indomethacin | High | High | Avoid | Potent renal vasoconstrictor | | Ibuprofen | High | Moderate–High | Avoid | Non-selective; fluid retention | | Ketorolac | High | Moderate | Avoid | Short-term only; nephrotoxic | **High-Yield:** Meloxicam is the NEET PG gold standard for chronic NSAID use in CKD and hypertension because it combines selectivity for COX-2 with a favorable renal and hemodynamic profile. **Clinical Pearl:** Always monitor serum creatinine and potassium at baseline and 2 weeks after initiation in CKD patients on any NSAID, even meloxicam. **Warning:** Even meloxicam should be avoided if eGFR <30 mL/min/1.73m² or if the patient has acute kidney injury, decompensated heart failure, or cirrhosis with ascites.