Short-Term Renal Function Monitoring by Physicians after Initiation of Antihypertensive Therapy: A Cross-Sectional KAP Survey in Sub-Saharan Africa

Introduction: Renin-angiotensin-aldosterone-system (RAAS) blockers are central to hypertension management due to their cardio- and nephroprotective effects. However, their initiation may cause a transient rise in serum creatinine, often misinterpreted as acute kidney injury, leading to inappropriate discontinuation. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding renal monitoring after antihypertensive initiation in sub-Saharan Africa. Methods: We conducted an analytical cross-sectional KAP survey among physicians across sub-Saharan Africa from January to March 2026 using an online questionnaire. The primary outcome was the proportion of participants correctly identifying the acceptable creatinine rise (≤30%) following RAAS initiation. Secondary outcomes included monitoring timelines, clinical decision-making, and perceived barriers. Data were analyzed using descriptive and inferential statistics. Results: A total of 136 physicians participated, predominantly from Central Africa (81.6%). Only 16.2% correctly identified the acceptable creatinine rise threshold. While 88.2% of respondents acknowledged the importance of post-initiation monitoring, only 34.6% reported performing it within the recommended 7 - 14 days. In a clinical scenario involving a 20% creatinine rise, only 21.3% selected the correct approach (continuing treatment with monitoring), whereas 78.7% modify or discontinue therapy inappropriately. No significant differences were observed between specialists and non-specialists. Financial constraints were the most frequently reported barrier to monitoring. Conclusion: Significant gaps in knowledge and practice regarding RAAS-related renal monitoring exist among physicians in sub-Saharan Africa. These deficiencies may contribute to suboptimal hypertension management. Targeted education, improved guideline dissemination, and health system interventions are needed to optimize care and preserve the benefits of RAAS therapy.