Page 127 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

INTRODUCTION
Self-monitoring: the reliability of patient-reported data 125
After kidney transplantation, an early detection of transplant failure is mandatory to minimize permanent damage to the transplanted organ. For kidneys, blood level of creatinine is considered the most important indicator of kidney function[1]. Patients therefore have their serum creatinine checked on average 20 times during the first year post-transplantation. As hypertension is both a potential indicator of decreased kidney function and an important risk factor for kidney graft failure[2-5], blood pressure needs extensive monitoring too. If patients were enabled to monitor both parameters at home, this would have important advantages. Self-monitoring could improve speed of rejection detection as measurements can take place more frequently while at the same time the high number of outpatient visits could be reduced and replaced by telephonic consults. Further, giving patients a more active role in their own care through self-monitoring has been shown to be of clinical benefit for a wide range of patients with chronic disease[6-15] and to lead to a higher quality of life[16-19]and more patient empowerment[7, 19-22].
A pilot study of our own group showed that self-monitoring of both blood pressure and creatinine is very well accepted among patients, suggesting that at-home monitoring after transplantation offers a promising strategy[23]. For self-monitoring to be a safe alternative to regular face-to-face follow-up, however, patients need to adhere to a monitoring schedule, report test results accurately and act upon test results if these suggest graft failure may occur. This is important for all patients who engage in self-monitoring, but especially for patients who are transplanted. As most patients who develop graft rejection are asymptomatic and present with an increased serum creatinine only, frequent measuring is essential to make the difference between treatment in time and damage to or even loss of the kidney transplant. Level of adherence to a self-monitoring schedule has been shown to vary widely in other disease populations [24-28]. Further, for self-measured values to be clinically useful, they need to be reported accurately. Several studies in different study populations have shown that caution is warranted when using patient reported data for making clinical decisions as a considerable number of patients report values that do not sufficiently represent their actual measurements[29-34].
To the best of our knowledge, no studies have assessed the reliability and accuracy of patient generated creatinine data or looked at level of adherence to a protocol of self-monitoring creatinine. This is unfortunate, as the introduction of self-monitoring offers a good opportunity to improve post- transplantation care. Our first research goal was to investigate the level of adherence of kidney transplant patients to a creatinine monitoring schedule. Our second research goal was to determine the reliability of the creatinine values that were registered in an online self-management support
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