Self-monitoring renal function after transplantation: a clinical trial on safety and usability

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C.L. van Lint, S. Van Dijk, M. van Diepen, W. Wang, W.P Brinkman, T. Rövekamp, M. Neerincx, T.A. Rabelink, P.J.M van der Boog

Chair(s): dr. Michiel G.H. Betjes, internist-nefroloog, Erasmus MC & dr. Erik A.M. Verschuuren, internist-klinisch immunoloog, UMCG

Wednesday 9 march 2016

14:50 - 15:00h at Theaterzaal

Categories: Plenaire sessie

Parallel session: Plenaire sessie III - Healthy ageing: Word je gezond oud na een orgaan-transplantatie?

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Background:
Enabling patients to monitor kidney function at home could decrease the high frequency of outpatients visits and improve speed of rejection detection. In this RCT, the safety and usability of self-monitoring creatinine and blood pressure with the support of a Disease Management System (DMS) during the first year post-transplantation was investigated.

Methods:
The intervention group used a Statsensor® Xpress™ to measure creatinine and a WatchBP® Home to measure blood pressure during the first year post-transplantation. Measurements were registered in a web-based system using a traffic light analogy to support interpretation of creatinine trends. The control group received usual care. Kidney function, blood pressure, quality of life and number of outpatients contacts (minutes spent) of both groups were assessed. Creatinine trends measured at home were compared to clinically relevant increases (>10%) measured in the hospital laboratory. A subsample of intervention patients (n=20) was interviewed on self-monitoring experiences.

Results:
In total 119 patients were included (77% response rate). A significant reduction in outpatient contacts was observed: 283 (SD 12) and 322 (SD 9) outpatient minutes spent for intervention and control group, respectively (p. 01). No differences were found for eGFR, blood pressure and quality of life. For 36 out of 71 laboratory-based creatinine increases, sufficient home-based creatinine measurements were available for trend comparison. A similar trend was observed between home-based and laboratory-based measurements in 78% of the cases. Self-monitoring enhanced early detection of rejection in 3 out of 5 cases, no rejections were missed. Satisfaction was high: 95% of the interviewed patients would recommend self-monitoring to other patients and 75% would have liked to extend self-monitoring creatinine beyond 1 year.

Conclusions:
This RCT shows that self-monitoring renal function after transplantation is highly appreciated by patients and enables number of outpatient visits to be significantly reduced without compromising on quality of care. With possibly improving the detection rate of relevant creatinine increases (e.g. due to increased measurement frequency), self-monitoring kidney function can play a useful role in post-transplantational care.