Self-Monitoring Kidney Function Post Transplantation: Reliability of Patient-Reported Data

Abstract

BackgroundThe high frequency of outpatient visits after kidney transplantation is burdensome to both the recovering patient and health care capacity. Self-monitoring kidney function offers a promising strategy to reduce the number of these outpatient visits.ObjectiveThe objective of this study was to investigate whether it is safe to rely on patients’ self-measurements of creatinine and blood pressure, using data from a self-management randomized controlled trial.MethodsFor self-monitoring creatinine, each participant received a StatSensor Xpress-i Creatinine Meter and related test material. For self-monitoring blood pressure, each participant received a Microlife WatchBP Home, an oscillometric device for blood pressure self-measurement on the upper arm. Both devices had a memory function and the option to download stored values to a computer. During the first year post transplantation, 54 patients registered their self-measured creatinine values in a Web-based Self-Management Support System (SMSS) which provided automatic feedback on the registered values (eg, seek contact with hospital). Values registered in the SMSS were compared with those logged automatically in the creatinine device to study reliability of registered data. Adherence to measurement frequency was determined by comparing the number of requested with the number of performed measurements. To study adherence to provided feedback, SMSS-logged feedback and information from the electronic hospital files were analyzed.ResultsLevel of adherence was highest during months 2-4 post transplantation with over 90% (42/47) of patients performing at least 75% of the requested measurements. Overall, 87.00% (3448/3963) of all registered creatinine values were entered correctly, although values were often registered several days later. If (the number of) measured and registered values deviated, the mean of registered creatinine values was significantly lower than what was measured, suggesting active selection of lower creatinine values. Adherence to SMSS feedback ranged from 53% (14/24) to 85% (33/39), depending on the specific feedback.ConclusionsPatients’ tendency to postpone registration and to select lower creatinine values for registration and the suboptimal adherence to the feedback provided by the SMSS might challenge safety. This should be well considered when designing self-monitoring care systems, for example by ensuring that self-measured data are transferred automatically to an SMSS.

Guided or factual computer support for kidney patients with different experience levels and medical health situations: preferences and usage

“…The overall 87% adherence rate observed was close to the upper limits of the 53%-85% adherence range to SMSS recommendation observed by renal transplant patients in the field [11]. Still, this is relative high compared to other adherence rates reported in the literature, for example 50% to physicians' medicine prescription for chronic diseases [24], 50% to treatment for chronic diseases in developed countries [25,26], 25% -59% to physicians' recommendations for colorectal cancer screening [27,28], 19% -96% in smoking cessation [29], 25% -40% in self-monitoring blood glucose for diabetes [30,31], and 52% for technology-mediated insomnia treatments [32].…”

“…It is important to make sure kidney transplant patients adhere to the self-monitoring routine and follow the SMSS recommendations in order for self-monitoring to be safe. However, a decline in adherence over time has been reported [11]. Furthermore, an additional complicating factor in this specific study setting was the imprecision of single measurement by the portable blood creatinine measure device [12].…”

Psychological and Psychopathological Aspects of Kidney Transplantation: A Systematic Review

“…Future directions of research should focus on deepening all those factors (self-efficacy, awareness disease, social and family support, health education) that influence the transplant preparation pathway and post-transplant results (32,80). Furthermore, the development of interdisciplinary interventions with the various specialists (surgeon, nephrologist, psychiatrist and psychologist) would be desirable to identify shared operational protocols for integrated care of the transplanted patient and also plan training and updating courses for the "health team" with particular attention to psychological, communicative and relational aspects (24,62,64,67,68,70,(75)(76)(77).…”

Self‐management challenges and support needs among kidney transplant recipients: A qualitative study

“…Self‐management support can be defined as the provision of interventions to increase patients’ skills and confidence in managing their chronic condition (Institute of Medicine Committee on Identifying Priority Areas for Quality, ). Attributed to the clinical importance of a strict regimen of immunosuppressive medication for maintaining graft functioning and the difficulties experienced with adherence (De Geest et al., ; Dew et al., ), self‐management support in the post‐transplant period has tended to focus on promoting medication adherence and self‐monitoring (De Bleser, Matteson, Dobbels, Russell, & De Geest, ; De Geest et al., ; van Lint et al., ). However, chronically ill patients indicate that they also struggle with the psychological and social demands of living with their condition (Wagner et al., ).…”

“…Psychosocial support includes recognition of the emotional burden of the chronic condition and building selfconfidence and empowerment . Besides generic challenges, chronically ill patients also experience disease specific self-management challenges and support needs (van Houtum, Rijken, Heijmans, & Groenewegen, 2015). To date, little is known about disease specific self-management support needs after kidney transplantation.…”