Page 25 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint
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 BACKGROUND
Patient experiences with self-monitoring after transplantation 23
Kidney transplantation is the treatment of choice for end stage renal disease (ESRD) patients. It is associated with a reduced risk of mortality and cardiovascular events as well as better quality of life than treatment with chronic dialysis.1 However, patients are at risk for acute rejection, predominantly in the first 6 months after transplantation.2 Most patients who develop acute rejection are asymptomatic and present only with an increased serum creatinine. Consequently, frequent laboratory monitoring is essential in order to detect a creatinine increase as early as possible. Further, as hypertension is both a potential indicator of decreased kidney function and an important risk factor for kidney transplant failure3-6, blood pressure needs to be closely monitored too. Besides being burdensome to healthcare capacity, the high frequent monitoring visits are a burden to patients. First, because many patients need to travel a considerable distance to get to the hospital. Second, because fear of rejection, the most common stressor among kidney transplant patients7-10, is more intense prior to clinical visits.10 The latter is conceivable, as the visits focus on discussing laboratory results that indicate how patients’ graft is functioning.
Being able to monitor creatinine and blood pressure at home could alleviate the burden of frequent outpatient visits and high levels of stress prior to consultations. With the development of a handheld point of care creatinine device, patients are now enabled to self-monitor creatinine. In contrast to self-monitoring creatinine, patients self-monitoring blood pressure is more common practice yet and the clinical benefits of home-based blood pressure measurements in kidney transplant patients have already been shown.11;12 However, experiences and satisfaction with self-monitoring of transplanted patients have never been taken into account. Research in other chronic disease populations shows that self-monitoring is generally highly valued by patients.13-17 However, this does not pertain to every patient. A factor that seems to influence patients motivation for and satisfaction with self-monitoring is level of trust. Patients have to trust the accuracy and reliability of the monitoring device(s)18;19 and their own self-monitoring skills20;21, and they have to experience support and trust from their clinician as well.22;23 Further, previous studies showed that self-monitoring increased patients’ feelings of security, reassurance and control over their own medical condition13;14;16;24;25, suggesting that worrisome patients have more to gain from self-monitoring than those worrying less. On the contrary, self-monitoring bodily symptoms can also rouse intrusive feelings of fear and doubt, especially when frequent self-monitoring picks up even small fluctuations.13;26
To the best of our knowledge, there is a lack of data about the attitude of kidney transplant patients towards self-monitoring. This poses a problem, as the feasibility of self-monitoring is highly dependent on the willingness and ability of patients to monitor at home.19;27 The aim of the current study was as
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