Page 105 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

INTRODUCTION
Self-monitoring of renal function: a randomised trial 103
Several studies have shown that patient self-monitoring can have significant clinical benefits for different chronic diseases, including reductions in HbA1c[1-4], improvements in blood pressure control[5-9], improved asthma control[10] and reductions in thromboembolic events[11, 12]. Self- monitoring has further been shown to lead to a higher quality of life[13-16] and more patient empowerment[16-19]. In addition, patients seem to prefer self-monitoring above regular care[8, 13, 14, 16, 17, 19].
Self-monitoring may also be a promising approach for follow-up of kidney transplant patients, with the frequent outpatient appointments constituting a high burden to healthcare systems and to patients. As many of these appointments are routine visits to monitor kidney function, self-monitoring creatinine and blood pressure at home has the potential to replace part of these visits by telephone contacts[20]. Further, as self-monitoring allows for measurements to take place more frequently, speed of rejection detection may be improved which could in the long run lead to improved kidney- graft survival[21-26].
To the best of our knowledge, there are no studies available that report on the usability of self- monitoring kidney function. Results from a pilot study of our own group did show that self-monitoring of creatinine and blood pressure is very well accepted by patients[27]. Our objective therefore was to investigate whether self-monitoring kidney function supported by a Self-Management Support System (SMSS) can lead to a reduction in number of outpatient visits in the first year post-transplantation without compromising on quality of care. To this end, we conducted a randomized controlled trial, comparing quality of care (eGFR, blood pressure, satisfaction, quality of life) and number of outpatient contacts between self-monitoring patients and patients receiving standard care.
METHODS
The ADMIRE study (Assessment of a Disease management system with Medical devices In RENal disease) was a randomized controlled trial (RCT) among kidney transplant patients performed at the University Medical Centre of Leiden (LUMC), The Netherlands. The study protocol was reviewed and approved by the Institutional Review Board of the LUMC (protocol number P11.188).
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