Page 156 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 7
In the last decade significant improvements in kidney transplant outcome have been achieved thanks to the availability of more effective immunosuppressive medications, and improved organ preservation, surgical techniques and antimicrobial prophylaxis [1].
However, patients continue to be at risk for acute rejection of their kidney graft, mainly in the first year after transplantation. The most important parameter for rejection is deterioration of renal function, measured by the concentration of serum level creatinine. As early detection of a rejection episode is mandatory to minimize permanent damage to the kidney graft[2-7], kidney transplant patients in the Netherlands visit the outpatient clinic about 20 times during the first year post-transplantation. Based on the experiences in other conditions where frequent monitoring is required, we expected that self- monitoring kidney function after transplantation has the potential to increase patient satisfaction[8- 14], detect complications after transplantation early [15, 16] and reduce healthcare consumption[17- 19] at the same time. With that, self-monitoring aligns seamlessly with the concept of value-based healthcare, a strategy that is increasingly being used to challenge the rising care expenditure and improve the quality of healthcare[20].
The general objective of this thesis was to investigate whether self-monitoring kidney function after transplantation supported by a self-management support system (SMSS) is well accepted and can replace part of regular care safely without loss of quality of care. Different studies have been performed to answer this question. The results of these studies will be discussed below, arranged by the main themes that have been described in the papers that are included in this thesis.
The acceptance of self-monitoring kidney function supported by an SMSS
Patient’s readiness to self-monitor
The feasibility of self-monitoring is highly dependent on the readiness of kidney transplant patients to monitor at home. The willingness to participate in the study and the satisfaction of patients who engaged in self-monitoring are important indications for this readiness. The response rate in both the pilot study (94%, as described in chapter 2) and RCT (77%, as described in chapter 5) shows that kidney transplant patients seem very motivated to self-monitor kidney function. The difference between these two studies is not fully explained, but may be partly due to the inclusion of recipients of deceased donor kidneys in the RCT but not in the pilot study. As these patients could not be recruited beforehand, they were approached shortly after transplantation, when they may still have been too overwhelmed with the event of the transplantation to decide on study participation. Further, these