Page 130 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 6
measurement was also termed day conclusion, as no further values could be registered. See figure1 for an overview of all possible feedback combinations.
A link was created between the SMSS and the electronic hospital system in order for the registered creatinine values to be visible for the treating nephrologist(s). Nephrologists did not receive a copy of the supplied SMSS feedback.
Procedure
The time schedule for providing instructions depended on whether patients participated in the living donor program or whether they received a kidney from a deceased donor. Two weeks prior to a scheduled transplantation, patients received account details to log in to the SMSS and use the eLearning module to prepare for self-monitoring. Recipients of a kidney from a deceased donor received account details during their post-transplantational stay in the hospital. A laptop was available to use the eLearning modules. After being virtually instructed through eLearning, all patients received the creatinine device and supplementary face-to-face instructions. Special attention was paid to the fact that patients had to take action themselves upon the system’s feedback, as their nephrologist(s) would only check the home-based creatinine values in advance of or during an outpatient visit or telephonic consult. Patients were then encouraged to practice using the creatinine device during the remainder of their hospital stay.
Home-based creatinine measurements had to be performed according to a fixed frequency, being daily during the first 4 weeks (phase 1), every other day for week 5-9 (phase 2), twice a week for week 10- 15 (phase 3) and weekly from week 16 onwards (phase 4). This scheme was based upon the usual frequency of laboratory testing, which decreases when time since transplantation increases. However, as the creatinine device tends to be less accurate than laboratory tests[35], the usual frequency of laboratory testing was multiplied with a factor seven to obtain a more reliable trend. After measuring, patients registered the results in the SMSS.
In addition to conducting regular creatinine measurements, patients were advised to perform a test measurement when opening a new bottle of test strips. These measurements could be termed test measurements by pressing a designated button on the creatinine device.
From week eight after transplantation on, every other face-to-face outpatient visit with regular hospital-based laboratory measurements was replaced by a telephonic consult to discuss self- monitored creatinine and blood pressure. Although regular face-to-face visits also include other laboratory measurements (e.g. trough levels of immunosuppressive medication), these analyses do not need to be performed in the same frequency as for creatinine due to their (expected) little