Volume : 13, Issue : 08, August – 2026
Title:
RENAL EFFECTS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS: A NARRATIVE REVIEW OF CLINICAL EVIDENCE AND PUBLIC HEALTH IMPLICATIONS IN INDONESIA
Authors :
Mohamed Yousef Ahmed Eltarjaman*, Diana Laila Ramatillah, Kashif Ullah Khan
Abstract :
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat pain, inflammation, and fever in both clinical and community settings. In Indonesia, these medicines are among the most frequently purchased drugs, available through both prescription and over-the-counter channels. Their easy access and frequent long-term use have raised concerns about kidney safety, especially for people with hypertension, diabetes, or previous kidney impairment. This narrative review explores evidence on the renal effects of NSAID exposure across Indonesian clinical contexts. Literature from 2015 to 2025 was identified through searches in Scopus, PubMed, ScienceDirect, Google Scholar, and local university repositories. Overall, renal complications have been reported after both short-term and longer-term NSAID exposure. Hospital studies in Indonesia report acute kidney injury linked to dehydration, infection, or inappropriate dosing, while outpatient data demonstrate gradual declines in kidney function when laboratory monitoring is lacking. Primary care prescribing studies in Indonesia report that most NSAID recipients are female (approximately 58–76%), although hospital pharmacovigilance data do not show consistent demographic patterning of renal injury. Self-medication with NSAIDs remains common, further increasing renal risk in these populations. Recent Indonesian studies also point to risks related to prescribing in primary care, medication-related harm in hospitals, and gaps in medication-safety governance. Despite national and international guidelines discouraging NSAID use in high-risk patients, routine renal monitoring is not consistently practiced. Strengthening pharmacist counselling, structured renal monitoring protocols, and public education strategies may significantly reduce preventable kidney injury while preserving appropriate and equitable access to NSAID therapy in Indonesia.
Keywords: NSAIDs, kidney injury, renal monitoring, chronic kidney disease, Indonesia
Cite This Article:
Please cite this article in press Mohamed Yousef Ahmed Eltarjaman et al., Renal effects of non-steroidal anti-inflammatory drugs: a narrative review of clinical evidence and public health implications in Indonesia.,, Indo Am. J. P. Sci, 2026; 13(08).
REFERENCES:
1. Abd ElHafeez S, Hegazy R, Naga Y, Wahdan I, Sallam S. Non-steroidal anti-inflammatory drugs among chronic kidney disease patients: an epidemiological study. Journal of the Egyptian Public Health Association. 2019 Jan 30;94(1):8.
2. Agussalim, A. (2025). Risk factors associated with chronic kidney disease among hemodialysis patients in Manado. JOJ Nursing & Health Care, 12(3), 45–52.
3. Andriani S, Rahmawati F, Andayani TM. Penyesuaian Dosis Obat pada Pasien Gagal Ginjal Kronis Rawat Inap di Rumah Sakit Kabupaten Tegal, Indonesia. Majalah Farmaseutik. 2021;17(1):46.
4. Apriani R. Evaluasi Penggunaan Dosis NSAID Pada Penyakit Gagal Ginjal Kronis Pasien Rawat Inap di Rumah Sakit Angkatan Udara dr. Esnawan Antariksa Halim Jakarta Tahun 2018 (Doctoral dissertation, Institut Sains dan Teknologi Nasional (ISTN)).
5. Armstrong MJ, Zhang K, Ye F, Klarenbach SW, Pannu NI. Population-based analysis of nonsteroidal anti-inflammatory drug prescription in subjects with chronic kidney disease. Canadian Journal of Kidney Health and Disease. 2023 Jan;10:20543581221149621.
6. Ayenew W, Tegegne AA, Genet G, Limenh LW, Yohannes L, Seid AM, Alemayehu TT, Simegn W. Self-medication with NSAIDs in Gondar city: prevalence, predictors, and public health implications. Scientific Reports. 2025 Jul 7;15(1):24178.
7. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochemical pharmacology. 2020 Oct 1;180:114147.
8. Bouck Z, Mecredy GC, Ivers NM, Barua M, Martin D, Austin PC, Tepper J, Bhatia RS. Frequency and associations of prescription nonsteroidal anti-inflammatory drug use among patients with a musculoskeletal disorder and hypertension, heart failure, or chronic kidney disease. JAMA internal medicine. 2018 Nov;178(11):1516-25.
9. BPOM (Badan Pengawas Obat dan Makanan). (n.d.). Assessment report: MOVI-COX® (etoricoxib) NSAID evaluation.Jakarta: BPOM RI.
10. Brennan R, Wazaify M, Shawabkeh H, Boardley I, McVeigh J, Van Hout MC. A scoping review of non-medical and extra-medical use of non-steroidal anti-inflammatory drugs (NSAIDs). Drug Safety. 2021 Sep;44(9):917-28.
11. Dalal R, Bruss ZS, Sehdev JS. Physiology, renal blood flow and filtration. InStatPearls [Internet] 2023 Jul 24. StatPearls Publishing.
12. Drożdżal S, Lechowicz K, Szostak B, Rosik J, Kotfis K, Machoy‐Mokrzyńska A, Białecka M, Ciechanowski K, Gawrońska‐Szklarz B. Kidney damage from nonsteroidal anti‐inflammatory drugs—Myth or truth? Review of selected literature. Pharmacology research & perspectives. 2021 Aug;9(4):e00817.
13. Fairuz N, Wahyuningsih S, Irmarahayu A, Nugrohowati N. Determinan penyakit ginjal kronik di Tangerang Indonesia: Studi Cross-sectional. Jurnal Ilmiah Kesehatan Masyarakat: Media Komunikasi Komunitas Kesehatan Masyarakat. 2024 Jun 4;16(2):63-70.
14. Faoziyah DP. Evaluasi penggunaan obat Nonsteroidal Anti Inflammatory Drugs (NSAID) pada pasien Rhematoid Arthritis di Instalasi Rawat Jalan RSUD Saiful Anwar Malang Tahun 2021 (Doctoral dissertation, Universitas Islam Negeri Maulana Malik Ibrahim).
15. Farmaka, Universitas Padjadjaran. (2019). Penggunaan NSAIDs dan efeknya terhadap aliran darah ginjal. Jurnal Farmaka, 17(3), 12–19.
16. Ghlichloo I, Gerriets V. Nonsteroidal anti-inflammatory drugs (NSAIDs).
17. Global Health Science Group. (2025). Analisis faktor risiko gagal ginjal akut akibat penggunaan NSAIDs di Kabupaten Kutai Timur. Indonesian Journal of Global Health Research, 7(1), 23–31.
18. Guthrie B. Can NSAIDs be used safely for analgesia in patients with CKD?: CON. Kidney360. 2020 Nov 1;1(11):1189-91.
19. Hsu CC, Wang H, Hsu YH, Chuang SY, Huang YW, Chang YK, Liu JS, Hsiung CA, Tsai HJ. Use of nonsteroidal anti-inflammatory drugs and risk of chronic kidney disease in subjects with hypertension: nationwide longitudinal cohort study. Hypertension. 2015 Sep;66(3):524-33.
20. Husain WA, Moosa RM, Awadh AM, Aladraj FM, Mahdi B, Haji SM, Chlif S, Alonge O, Shehata MH. The prevalence and contributing factors of NSAIDs prescription among chronic kidney disease patients in primary care: a mixed methods study from Kingdom of Bahrain. BMC Primary Care. 2025 Apr 17;26(1):116.
21. Hustrini NM. Chronic kidney disease care in Indonesia: challenges and opportunities. Acta Medica Indonesiana. 2023 Mar 31;55(1):1-.
22. Hustrini NM, Susalit E, Rotmans JI. Prevalence and risk factors for chronic kidney disease in Indonesia: An analysis of the National Basic Health Survey 2018. Journal of global health. 2022 Oct 14;12:04074.
23. Kamri AM. An evaluation of the relationship between the occurrence of chronic kidney disease and the use of NSAIDs. Bali Medical Journal. 2023;12(1):153-7.
24. Kamal, Y. A., Anggriani, Y., & Ramadaniati, H. U. (2020). Evaluasi perilaku penggunaan obat sebelum pasien terdiagnosa penyakit ginjal kronis di rsud soesilo kabupaten tegal dan rsud kardinah kota tegal periode januari – agustus 2016. Journal Ilmiah Farmasi, 9(2), 42-49.
25. Kasturi J, Palla PR, Bakshi V, Bogg N. Non-steroidal anti-inflammatory drugs: an overview. Journal of Drug Delivery & Therapeutics. 2019 Jan 2.
26. KDIGO. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease.Kidney International Supplements, 14(3), 1–132.
27. Kemkes RI (Kementerian Kesehatan Republik Indonesia). (2018). Laporan Nasional RISKESDAS 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan.
28. Kemkes RI (Kementerian Kesehatan Republik Indonesia). (2023). Pedoman nasional pelayanan kedokteran tata laksana penyakit ginjal kronik. Jakarta: Direktorat Jenderal Pelayanan Kesehatan.
29. Klomjit N, Ungprasert P. Acute kidney injury associated with non-steroidal anti-inflammatory drugs. European journal of internal medicine. 2022 Jul 1;101:21-8.
30. Kusumawardani LA, Risni HW, Naurahhanan D, Syed Sulaiman SA. Assessment of potentially nephrotoxic drug prescriptions in chronic kidney disease outpatients at a hospital in Indonesia. International Journal of Nephrology and Renovascular Disease. 2025 Dec 31:59-69.
31. Kuswinarti K, Rohim AB, Aminah S. Attitude and behavior towards self-medication using non-steroidal anti-inflammatory drugs and paracetamol among housewives in Hegarmanah Village, Jatinangor. Althea Medical Journal. 2020 Mar 28;7(1):25-30.
32. LaForge JM, Urso K, Day JM, Bourgeois CW, Ross MM, Ahmadzadeh S, Shekoohi S, Cornett EM, Kaye AM, Kaye AD. Non-steroidal anti-inflammatory drugs: clinical implications, renal impairment risks, and AKI. Advances in therapy. 2023 May;40(5):2082-96.
33. Mallamaci F, Tripepi G. Risk factors of chronic kidney disease progression: between old and new concepts. Journal of Clinical Medicine. 2024 Jan 24;13(3):678.
34. Meylani M. Rasionalitas Penggunaan Obat Anti Inflamasi Non Steroid (OAINS) Pada Pasien Rawat Jalan Di Puskesmas Putri Ayu Kota Jambi Tahun 2023 (Doctoral dissertation, Kedokteran).
35. Muharni S, Hasti S, Meidhika R, Aryani F, Husnawati H. Analisis Faktor Risiko Penggunaan Obat Anti-Inflamasi Nonsteroid Jangka Panjang terhadap Penyakit Ginjal Kronik di RSUD Arifin Achmad Provinsi Riau. JPSCR: Journal of Pharmaceutical Science and Clinical Research. 2025 Jul;10(2):238-48.
36. Nasution ES, Mukhtar R. Pattern of prescribing NSAIDs utilisation at outpatient pediatric poly at Universitas Sumatera Utara hospital. Open Access Macedonian Journal of Medical Sciences. 2019 May 14;7(10):1631.
37. Ridwan BA, Fety Y, Nurlinda N. Evaluasi Rasionalitas Penggunaan Obat Anti Inflamasi Non Steroid (OAINS) Di Puskesmas Poli-Polia Kabupaten Kolaka Timur. Jurnal Mandala Pharmacon Indonesia. 2021 May 27;7(1):1-8.
38. Rudang SN, Rambe RE, Annisa S. Identifikasi Drug Related Problems Pada Pasien Penyakit Ginjal Kronis Di Rumah Sakit Prof. dr. Chairuddin Panusunan Lubis Tahun 2023. Indonesian Journal of Pharmaceutical and Clinical Research. 2024 Nov 16;7(1):34-45.
39. Shukla A, Rai MK, Prasad N, Agarwal V. Short-term non-steroid anti-inflammatory drug use in spondyloarthritis patients induces subclinical acute kidney injury: biomarkers study. Nephron. 2017 Apr 3;135(4):277-86.
40. Sinuraya RK, Wulandari C, Amalia R, Puspitasari IM. Public knowledge, attitudes, and practices regarding the use of over-the-counter (OTC) analgesics in Indonesia: a cross-sectional study. Patient Preference and Adherence. 2023 Dec 31:2569-78.
41. Soliman S, Ahmed RM, Ahmed MM, Attia A, Soliman AR. Non-steroidal anti-inflammatory drugs: what is the actual risk of chronic kidney disease? A systematic review and meta-analysis. Romanian Journal of Internal Medicine. 2025 Mar 31;63(1):3-27.
42. Sukmawati IK, Melysa M, Karimah K, Widyastuti L, Alayubi D, Azzahra F. Optimalisasi Peran Tenaga Teknis Kefarmasian (TTK) Dan Persatuan Ahli Farmasi Indonesia (PAFI) Dalam Swamedikasi Sediaan Obat Syrup Diduga Penyebab Gangguan Ginjal Pada Anak. Jurnal Pengabdian Mandiri. 2023;2(1):83-92.
43. Suriyong P, Ruengorn C, Shayakul C, Anantachoti P, Kanjanarat P. Prevalence of chronic kidney disease stages 3–5 in low-and middle-income countries in Asia: A systematic review and meta-analysis. PLoS One. 2022 Feb 25;17(2):e0264393.
44. Farhanah Syafhan N, Shafa Aldora G, Kamila S. Assessment of medication-related liver and kidney impairment in admitted patients in Depok, Indonesia: an observational study employing the Naranjo algorithm.
45. Teo SH, Tan NC, Choo JC, Kwek JL, Kadir HB, Bee YM, Huang H, Kaushik M, Ang AT, Lim CC. Non-steroidal anti-inflammatory drugs in chronic kidney disease and risk of acute adverse kidney events according to route of administration. International Urology and Nephrology. 2023 Mar;55(3):679-86.
46. Wan EY, Yu EY, Chan L, Mok AH, Wang Y, Chan EW, Wong IC, Lam CL. Comparative risks of nonsteroidal anti-inflammatory drugs on CKD. Clinical Journal of the American Society of Nephrology. 2021 Jun 1;16(6):898-907.
47. Wimalawansa SJ, Dissanayake CB. Factors affecting the environmentally induced, chronic kidney disease of unknown aetiology in dry zonal regions in tropical countries—novel findings. Environments. 2019 Dec 18;7(1):2.
48. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging and disease. 2018 Feb 1;9(1):143.
49. Yang L. Acute kidney injury in Asia. Kidney diseases. 2016 Apr 9;2(3):95-102.
50. Zhan M, Doerfler RM, Xie D, Chen J, Chen HY, Diamantidis CJ, Rahman M, Ricardo AC, Sondheimer J, Strauss L, Wagner LA. Association of Opioids and Nonsteroidal Anti-inflammatoryáDrugs With Outcomes in CKD: áFindings From the CRIC (Chronic Renal Insufficiency Cohort) Study. American Journal of Kidney Diseases. 2020 Aug 1;76(2):184-93.