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Impact of Kidney Function Screening on Early Detection of Kidney Disease among Adults with Hypertension in Nigeria

Abstract

Kidney disease is an important public health concern among adults with hypertension because persistent elevated blood pressure may contribute to progressive kidney damage and chronic kidney disease. Kidney disease may develop gradually without obvious symptoms, making early detection particularly important for individuals with hypertension who are at increased risk. In Nigeria, limited awareness, inadequate routine screening, financial constraints, restricted access to healthcare facilities, and delayed healthcare utilization may contribute to late identification of kidney abnormalities. Kidney function screening provides an opportunity to identify early abnormalities in renal function and facilitate timely clinical assessment, treatment, monitoring, and lifestyle modification. Against this background, this study investigates the impact of kidney function screening on early detection of kidney disease among adults with hypertension in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Chronic Care Model. The Health Belief Model explains how individuals' perceptions of their susceptibility to kidney disease, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in kidney function screening. Andersen's Behavioral Model explains healthcare utilization through predisposing characteristics, enabling resources, and healthcare needs. The Chronic Care Model emphasizes proactive healthcare, regular monitoring, patient education, clinical follow-up, and coordinated management of chronic conditions. Collectively, these theoretical perspectives provide a suitable framework for explaining how kidney function screening may influence early detection of kidney disease among adults with hypertension in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above with diagnosed hypertension attending selected healthcare facilities or residing in selected communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, healthcare facilities, and eligible participants. Kidney function screening will be assessed using indicators such as availability of screening services, frequency of screening, accessibility of testing, blood pressure monitoring, serum creatinine assessment, estimated glomerular filtration rate, urine albumin or protein assessment where appropriate, availability of trained healthcare personnel, laboratory capacity, screening referral, and follow-up arrangements. Early detection of kidney disease will be assessed using indicators such as newly identified abnormal kidney function results, reduced estimated glomerular filtration rate, albuminuria or proteinuria, suspected chronic kidney disease, referral for further clinical evaluation, confirmed kidney disease following appropriate assessment, and initiation of appropriate monitoring or management. Data will be collected using structured questionnaires, clinical records, laboratory results, kidney function screening registers, referral records, and relevant healthcare programme documents, subject to appropriate ethical and confidentiality safeguards. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, kidney function findings, and patterns of early kidney disease detection. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of kidney function screening on early detection of kidney disease. Where a quasi-experimental design is adopted, detection rates before and after implementation of the screening programme may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that kidney function screening has a significant positive impact on early detection of kidney disease among adults with hypertension in Nigeria. Adults with hypertension who participate in routine kidney function screening are expected to have a higher likelihood of previously undetected renal abnormalities being identified than individuals without access to regular screening. Early identification of abnormal kidney function may provide opportunities for timely clinical evaluation, improved blood pressure management, appropriate treatment, lifestyle modification, monitoring, and referral to specialist care where necessary. Integrating kidney function assessment into hypertension management may strengthen continuity of care and encourage patients to understand the importance of monitoring potential complications. However, limited laboratory capacity, cost of diagnostic tests, inadequate healthcare personnel, poor access to healthcare facilities, inconsistent follow-up, low patient awareness, and financial constraints may reduce screening coverage and programme effectiveness. The study therefore expects accessible, affordable, routine, and well-integrated kidney function screening services to contribute significantly to improved early detection and management of kidney disease among adults with hypertension in Nigeria. The study is expected to contribute to the literature on kidney function screening, early detection of kidney disease, hypertension complications, chronic kidney disease prevention, preventive healthcare, non-communicable disease management, primary healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare facilities, hospitals, nephrologists, healthcare professionals, community health workers, development partners, and policymakers regarding strategies for improving kidney disease prevention and early detection among individuals with hypertension. The study will also provide evidence-based recommendations for integrating routine kidney function assessment into hypertension management, improving access to affordable laboratory services, strengthening patient education, increasing screening coverage, improving referral and follow-up systems, and developing sustainable programmes for early detection of kidney disease across Nigeria.

Keywords: Kidney function screening, early detection, kidney disease, hypertension, chronic kidney disease, renal function, preventive healthcare, blood pressure management, primary healthcare, Nigeria, public health.