Page 38 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

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Chapter 2
measurements indicates a high need for reassurance. In the current study, however, no relation was found between measurement frequency and level of transplant related worries. Besides patients performing more measurements than required, some patients did not adhere to the protocol and their number increased over time. The current dataset did not offer a clear-cut explanation for this finding, although a trend for a negative relation between measurement frequency and amount of variation in subsequent creatinine test results was observed. This suggests the existence of a relation between higher amount of variation and lower measurement frequency and vice versa. In addition to the suggested role of level of variation, two features of this study could have contributed to a lower level of adherence over time. First, the limited attention some physicians paid to measurement results might have reduced the perceived need to perform the measurements. Second, as self-monitoring creatinine and blood pressure was an add-on service to regular outpatient care, patients were not dependent upon their own measurements for information on their kidney function. This could have diminished patients’ perceived need to self-monitor. Adherence might therefore improve when monitoring at home has a more prominent role in post-transplantational care instead of being just an add-on service. Nevertheless, protocol non-adherence remains a serious issue to consider in future studies to ensure safety of self-monitoring.
CONCLUSION
To the best of our knowledge, this is the first study to investigate the possibility of self-monitoring kidney function after kidney transplantation and the first study on kidney transplant patients’ attitude towards self-monitoring. The results show that self-monitoring creatinine and blood pressure after kidney transplantation is well received by kidney transplant patients. However, the relatively small number of participants and the selection of recipients of living donor kidneys prevents us from drawing strong conclusions that can be generalized to the entire kidney transplant population. Further, as non-responders to the follow-up questionnaire seemed to be somewhat less positive about self-monitoring at baseline, the absence of their follow-up experiences could have introduced a small bias towards a positive evaluation.
Overall, our results suggest that a self-monitoring care system has the potential to improve post- transplantational care in several ways. Firstly, by increasing patient satisfaction.14;17;24;27;37;38;50-52 Secondly, by decreasing the high number of outpatient visits, as important parameters can be monitored at home. Finally, by advancing the detection of acute rejection and hypertension due to higher frequent monitoring, which may improve kidney graft survival.5;53-59 Future studies should