Page 26 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 2
follows. Firstly, to study kidney transplant patients’ willingness to self-monitor after kidney transplantation and their experiences with self-monitoring. Secondly, to assess how worries and trust regarding devices, personal skills and the doctor-patient interaction are related to experienced level of satisfaction. Thirdly, to study patients’ adherence to the measurement protocol, as a good adherence to the protocol is a prerequisite for safety from a clinical point of view.
MATERIALS AND METHODS
Subject and methods
This prospective pilot study was performed at the Leiden University Medical Centre in advance of a randomized control trial on the applicability of self-monitoring after kidney transplantation. The study protocol was reviewed and approved by the Medical Ethics Committee. Patients were recruited from June 2010 to January 2011, at 2-4 weeks prior to a living donor transplantation. Inclusion criteria were being ≥ 18 years of age, mastering the Dutch language and having access to the Internet. All participants provided written informed consent.
All patients received transplant care as usual. Immunosuppressive regimens comprised of basiliximab for induction (except for one patient receiving Alemtuzumab) and glucocorticoids, tacrolimus and mycophenolate mofetil for maintenance therapy. To optimize levels of the immunosuppressive agents regular monitoring of through levels was combined with monitoring systemic exposure (as measured by areas under the curve) at 6 weeks and 6 months post-transplantation and yearly afterwards.
In addition to regular outpatient care, participants monitored level of whole blood creatinine and blood pressure at home during the first 12 weeks after kidney transplantation. They received a planning starting from the day after discharge. Measurement frequency was decreased stepwise, ranging from daily in the first weeks to once a week in weeks 9-12. Patients registered their measurement results in an online disease management system (DMS) to which their physician had access too.
Patients completed a questionnaire at discharge from hospital after kidney transplantation (i.e. baseline) and at the end of the study period after twelve weeks (i.e. follow up). Baseline questionnaires and return envelopes were supplied one day in advance of discharge from the hospital. Follow-up questionnaires were sent out after completing the study period, that is after 12 weeks. The first 10 patients who finished participation were interviewed about their experiences. A semi- structured protocol was applied with open-ended questions that reflected topics from the questionnaire (see Supplemental table 1). Interviews were recorded and transcribed in full. As