Page 119 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

Self-monitoring of renal function: a randomised trial 117
already high at the first measurement for both intervention and control patients, leaving little room for improvement over time. Two other factors may have further contributed to the equal levels of satisfaction with care. First, the CSQ may have been too general to capture more subtle differences in satisfaction as it referred to ‘all’ care patients had received. Second, as the number of ftf visits that was replaced by a telephonic consult was lower than expected, intervention and control patients received more similar care, potentially resulting in equal levels of satisfaction.
To the best of our knowledge, this is the first study to investigate the potential of self-monitoring kidney function to replace part of the highly frequent outpatient visits after kidney transplantation. The fact that we used an RCT design is an important strength, as an RCT is the most robust design when studying intended treatment effects, eliminating potential confounding by indication. Further, due to the use of linear mixed modelling and multiple imputations, both addressing the issue of missing data, all patients could be included in the analyses. The reported results concerning the involvement of doctors in the self-monitoring protocol adds to the clinical relevance of this paper.
Our findings must also be evaluated within the context of the limitations of this study. First, all participants were recruited from a single centre. Second, nearly 90% of our study participants were transplanted with a kidney from a living donor. Third, from all kidney transplantations that were performed during period of inclusion, 44% of the transplant patients were ineligible for participation or did not want to participate. This could suggest that self-monitoring kidney function after transplantation is suitable for a selected group of kidney transplant recipients only.
In conclusion, this study shows that self-monitoring kidney function after transplantation has the potential to increase patient satisfaction and accelerate the detection of kidney function deterioration while reducing healthcare consumption at the same time. With the growing availability of other techniques, for example dried blood spot techniques (DBS), even more analyses can now be performed with capillary samples obtained at home. It has recently been shown that DBS techniques can successfully be applied for the analysis of immunosuppressant medication concentration and creatinine[42, 43], the most important parameters to be monitored after kidney transplantation. Using a system in which all home measurement results are combined, reference values that are tailored to an individual patient and to which both patients and healthcare professionals have access, self- management of kidney transplant patients can be elevated to a higher level.
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