Renal transplant patient acceptance of a self-management support system.

BACKGROUND: Self-management support systems (SMSS) have been proposed for renal transplant patients to increase their autonomy and reduce the number of hospital visits. For the design and implementation of such systems, it is important to understand factors influencing patients' acceptance of a SMSS. This paper aims to identify these key factors. METHODS: From literature, possible factors and related questionnaire items were identified. Afterwards, focus groups with experts and patients were conducted to adapt the items to the application domain. To investigate acceptance of a SMSS and the influencing factors, fifty renal transplant patients answered the questionnaire before and after using the SMSS for 4 months. RESULTS: All the questionnaire constructs had a satisfactory or higher level of reliability. After using the SMSS for 4 months, trust and performance expectancy could explain part of the variation in behavioural intention of using the SMSS, but not beyond the explanation given by patients' affect towards the system, which accounted for 26% of the variance. CONCLUSIONS: We anticipate that in future caregivers implementing a SMSS will benefit from taking steps to improve patients' affect as this was found to correlate with patients use intention. TRIAL REGISTRATION: The study was registered in ToetsingOnline, a registry held by the Dutch Central Committee on Research Involving Human Subjects. The registration number is NL33387.058.11 , and the date of registration is 31st July 2012.

Application of a point of care creatinine device for trend monitoring in kidney transplant patients: fit for purpose?

BACKGROUND: The StatSensor® Xpress-i™, a point-of-care system for blood creatinine measurement, offers patients the possibility of self-monitoring creatinine. In this study, the analytical performance of the StatSensor® for both detecting current renal function and monitoring renal (dys)function in kidney transplant patients was examined. METHODS: Accuracy of the StatSensor® with capillary and venous whole blood was evaluated and compared to an isotopic dilution mass spectrometry (IDMS)-traceable enzymatic creatinine test in venous serum (n=138). Twenty Li-heparin samples were compared to the IDMS reference method performed by a Joint Committee for Traceability in Laboratory Medicine (JCTLM)-listed reference laboratory (RfB, Bonn, Germany). To evaluate StatSensor®'s suitability to monitor kidney function, both venous and capillary samples were obtained in 20 hospitalized transplantation patients. Venous samples were analyzed with an IDMS-traceable enzymatic test, capillary samples were measured using the StatSensor®. For all 2-day intervals, percentage change in creatinine was compared between both methods. RESULTS: The StatSensor® did not meet total allowable error criterion of 6.9%. Average overall CVa for the StatSensor® was 10.4% and 5.2% for capillary and venous whole blood results, respectively. Overall CVa for the central laboratory serum creatinine method was <1.5%. For monitoring renal (dys)function, total agreement of the StatSensor® with an IDMS-traceable enzymatic test was 68% using a 10% Δ change. No significant differences were found between the changes observed by both methods. CONCLUSIONS: Capillary blood testing with the StatSensor® is not advisable for determining current renal function with a single creatinine measurement in kidney transplant patients, mainly due to excessive analytical imprecision. However, our results suggest that capillary blood testing with the StatSensor® can be used for daily trend monitoring of kidney function after renal transplantation.