Patient experiences with self-monitoring renal function after renal transplantation: results from a single-center prospective pilot study

Figures & data

Table 1 Characteristics of the questionnaires

Questionnaire (reliability, if applicable)	Items, n	Example	Time point	Scale
Overall satisfaction	1	On a scale of 1–10, how satisfied are you with the offered self-monitoring facilities?	Baseline, follow-up	1–10
Specific aspects of satisfaction	15	Number of outpatient appointments	Follow-up	1, want it to be diminished to 5, want it to be increased
Advantages of self-monitoring	12	It is an advantage to check creatinine as often as wanted	Baseline, follow-up	1, disagree to 5, agree
Disadvantages of self-monitoring	13	It is a disadvantage that I have to puncture my finger	Baseline, follow-up	1, disagree to 5, agree
Experiences with using the creatinine and blood pressure device	10 (5 per device)	Having a creatinine device is …	Baseline, follow-up	1, annoying to 5, pleasant 1, not reassuring to 5, reassuring 1, frightening to 5, not frightening 1, useless to 5, useful 1, frustrating to 5, not frustrating
Trust in accuracy	2 (1 per device)	I have confidence in the accuracy of the blood pressure device	Baseline, follow-up	1, totally disagree to 5, totally agree
Self-efficacy (α=0.97)	6	I am able to correctly interpret measurement results	Baseline, follow-up	1, totally disagree to 5, totally agree
Autonomy supportiveness (α=0.96)	15	My physician encourages me to ask questions	Follow-up	1, strongly disagree to 5, strongly agree
Transplant- related worries (α=0.66)	4	I am worried about damaging my transplant	Baseline, follow-up	1, strongly disagree to 5, strongly agree

Table 2 Characteristics of study population

Characteristics	Study population (n=30)
Sociodemographic
Age (years)
Mean ± SD	49.5±13.01
Range	25–70
Male, n (%)	10 (33.3)
Marital status, n (%)
Single	4 (13.3)
Married or living together	26 (86.7)
Nationality, n (%)
Dutch	27 (90)
Other	3 (10)
Educational level, n (%)
Low	9 (30)
Middle	9 (30)
High	12 (40)
Clinical
Renal status prior to transplantation, n (%)
Preemptive	17 (57)
Dialysis-dependent	13 (43)
Hemodialysis	8 (27)
Peritoneal dialysis	5 (16)
Creatinine (µmol/L), mean (SD)
Baselineb	132 (35)
Follow-upb	134 (37)
eGFR,a mean (SD)
Baselineb	51 (19)
Follow-upb	49 (11)
MAPc (mmHg), mean (SD)
Baselined	101 (7)
Follow-upd	97 (13)

Notes:

a Laboratory-based assessment;

b baseline = measured at first outpatient consult (mean 13 days since transplantation), follow-up = measured at first outpatient consult after finishing study participation (mean 101 days since transplantation);

c home-based assessment;

d baseline = first value measured at home (mean 8 days since transplantation), follow-up = last value measured at home (mean 88 days since transplantation).

Abbreviations: SD, standard deviation; MAP, mean arterial pressure; eGFR, estimated glomerular filtration rate.

Table 3 Patient quotes from the interviews (n=10)

Quote 1	“The accuracy (of the creatinine device) is not optimal. That’s why you start to take everything with a pinch of salt after a while”. Male, age 38 years
Quote 2	“When you’ve seen it once, you can start doing it yourself right away”. Male, age 38 years
Quote 3	“That you’re on top of it yourself is the most important to me”. Male, age 51 years
Quote 4	“When I took the list with all my measures with me, the doctor only looked at my blood pressure”. Male, age 65 years
Quote 5	“It gives a sense of security that if something happens, you notice it right away”. Male, age 65 years
Quote 6	“I sometimes get the idea that the outpatient appointments are only there to remind a physician to check his patients’ values”. Male, age 57 years

Figure 1 Patients’ experiences with using the creatinine and blood pressure device at follow-up.

Notes: ^aHaving access to a creatinine device is pleasant/reassuring/useful; ^bI have trust in the accuracy of the creatinine/blood pressure meter; ^cOn a scale of 1 (unpleasant/not reassuring/useless/totally disagree) to 5 (pleasant/reassuring/useful/totally agree).

Table 4 Experience of advantages and disadvantages of self-monitoring at baseline and follow-up

	Baseline		Follow-up		Dependent t-test
	Mean*	SD	Mean*	SD	P-value
It is an advantage that …
I can control creatinine regularly	4.20	0.91	3.84	1.38	0.15
I can control blood pressure regularly	4.20	0.91	4.08	1.15	0.60
Physicians have direct access to results	4.72	0.46	3.96	1.31	<0.01
Changes in my condition are noticed quickly	4.76	0.52	4.08	1.19	0.02
I have to take up a more active role in my own care	4.68	0.56	4.04	1.06	<0.01
I receive a warning in case of raised creatinine levels	4.76	0.44	4.20	1.04	0.01
It is a disadvantage that …
I have to perform measurements myself	1.60	1.00	1.36	0.91	0.16
Performing the measurements takes time	2.00	1.32	1.48	0.92	0.05
I have to interpret results myself	1.72	1.17	1.16	0.47	0.03
I have to keep track of values digitally	1.88	1.13	1.12	0.44	<0.01
I have to take up a more active role in my own care	1.68	1.18	1.36	0.91	0.12

Note:

* On a scale of 1 (disagree) to 5 (agree).

Abbreviation: SD, standard deviation.

Figure 2 Percentage adherence to measurement frequency per protocol.

Notes: ^*Measurement frequency: week 1–3, daily; week 4–6, every other day; week 7–9, twice a week; week 10–12, weekly.

Figure S1 Study flowchart.

Table S1 Interview protocol

Subject	Questions
Satisfaction	• What did you think of using the creatinine device and blood pressure meter?
	• Would you recommend this system of self-monitoring to other patients?
	◦ What would you tell them?
Self-monitoring skills	• How did you experience interpreting test results yourself?
Self-monitoring in care	• Due to self-monitoring other way of dealing with kidney disease?
	• Did you feel (more) involved in treatment?
	• Effect of self-monitoring on relationship with physician?
	• Opinion on replacing part of polyclinic visits by telephonic consults based on self-measured results?