Page 15 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

after kidney transplantation has not yet received a great deal of attention. Studies that did cover this subject focused on the viability of self-monitoring blood pressure after kidney transplantation, showing that self-monitoring blood pressure is an effective way to detect poor control of hypertension[52-54]. Although blood pressure is an important parameter to be monitored after transplantation, healthcare professionals and patients are especially interested in serum level of creatinine. Creatinine is a waste product of the muscles that is filtered from the blood by the kidneys. In case of a deteriorating kidney function, for example due to rejection, the level of creatinine and other waste products in the blood will increase. Besides the accumulation of waste products in the body, which eventually becomes toxic, a decreased kidney function leads to increased blood pressure via two routes. First, as kidneys filter and excrete excess fluid, suboptimal kidney function leads to the accumulation of fluid in the body resulting in an increased pressure that is put on the blood vessels. Second, the kidneys play an important role in keeping blood pressure in a healthy range by the excretion of blood pressure regulating hormones. Decreased renal function will therefore result in suboptimal blood pressure regulation. The relationship between kidney function and blood pressure is bi-directional: through the increased pressure that is put on the vessels, the dense network of blood vessels present in the kidneys can become damaged, reducing the ability to remove waste and excess fluid from the body. This will again lead to increased pressure that is put on the blood vessels, resulting in a downwards spiral. The narrow relationship between kidney function and blood pressure makes the frequent monitoring of both parameters necessary.
Aim and outline of this thesis
Based on the experiences in other conditions requiring chronic care, self-monitoring kidney function after transplantation has the potential to increase patient independency and satisfaction and accelerate the detection of complications while reducing healthcare consumption at the same time. The general objective of this thesis was to investigate whether self-monitoring kidney function after transplantation supported by an online self-management support system is well accepted by patients, and can replace part of regular care safely and without loss of quality of care. The different studies that have been performed to answer this question are outlined below.
Chapter 2. Enabling patients to monitor kidney function at home could decrease the high frequency of outpatients visits and improve speed of rejection detection. For this to be possible, however, patients have to be willing to self-monitor. In this chapter, the results of a prospective pilot study investigating patients’ experiences and satisfaction with self-monitoring kidney function after transplantation are described.
General Introduction 13
1