Key result
Among kidney transplant recipients self-monitoring their kidney function, 87% of registered creatinine values were entered correctly, though patients frequently postponed registration and selectively reported lower values.
Why the study?
Is it safe to rely on patients' self-measurements of creatinine and blood pressure post kidney transplantation?
Cohort (n=58)
Open-label
Preset randomization schedule (for parent RCT)
No
Is it safe to rely on patients' self-measurements of creatinine and blood pressure post kidney transplantation?
Patients self-monitoring kidney function post-transplant tend to postpone registration and selectively report lower creatinine values, highlighting the need for automated data transfer to ensure safety.
Self-reported creatinine values may be unreliable post-transplant due to delays and bias; leaves open whether automated transfer improves safety.
BACKGROUND: The 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. OBJECTIVE: The 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. METHODS: For 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. RESULTS: Level 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. CONCLUSIONS: Patients' 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.
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Lint et al. (2017) conducted a cohort in Kidney Transplantation (n=58). Self-monitoring of creatinine and blood pressure with a Web-based Self-Management Support System (SMSS) was evaluated on Correctly entered registered creatinine values. Among kidney transplant recipients self-monitoring their kidney function, 87% of registered creatinine values were entered correctly, though patients frequently postponed registration and selectively reported lower values.
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