Self-testing kidney function from home is feasible for select transplant recipients
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Key takeaways:
- Training patients to self-test kidney function at home is possible.
- Self-tested potassium results differed from clinic tests, but not because of patients’ use of tests.
Select transplant recipients can successfully self-test kidney function at home after training, according to data published in the Kidney International Reports.
Further, the success rate of self-testing is close to the success rate of tests conducted in clinics.
“Enabling patients to self-test kidney function at home could reduce their need to attend health care facilities. Reducing clinic attendance or hospital stay for monitoring of kidney function is an attractive value proposition for health care services. Home self-testing could also facilitate personalized care pathways, empowering patients to organize health care monitoring around their daily activities,” Jonathan S. Murray, MBBS, MRCP, BSc, from the South Tees Hospitals National Health Service (NHS) Foundation Trust in the United Kingdom, and colleagues wrote. They added, “Currently licensed technology does not therefore enable real-time patient self-testing at home and does not include potassium testing, which is often a time-sensitive and clinically important test alongside creatinine for many patients with kidney disease and other long-term health conditions.”
In a prospective, observational, single-center, clinical feasibility study, researchers examined 15 kidney transplant recipients registered with South Tees Hospitals NHS Foundation Trust. Patients underwent training to use the Abbott i-STAT Alinity analyzer (i-STAT), which is a portable hand-held in vitro analyzer. Patients used this to index self-test potassium and creatinine in finger-prick capillary blood samples once a week for 4 weeks. Nurses also took the reference test measurements on the same day as index self-tests.
Researchers considered the agreement between potassium and creatinine results from index patient self-test and reference standard tests as the primary outcome of the study.
Overall, the mean within-patient difference between index and reference tests in creatinine was 2.25 µmol per liter and 0.66 mmol per liter for potassium. Analyses revealed all creatinine pairs to be clinically equivalent, while 67.5% of potassium pairs were clinically equivalent.
Compared with the success rate of tests taken by nurses in clinics (73% of tests were successful), patients showed a 70% success rate at home. Moreover, about 30% of the capillary blood tests did not show a result for creatinine or potassium, including tests done by nurses. A follow-up analysis showed that the differences were not due to patient use of hand-held devices to self-test. In fact, researchers suggest that biochemical variables correlated with potassium measurement in capillary blood could be responsible for the paired-test result differences.
“Our small feasibility study findings demonstrate it is possible for selected patients to use hand-held devices to safely and competently self-test kidney function at home,” Murray and colleagues wrote. “However, further studies are required to validate our findings and to evaluate other devices, with potentially different patient usability characteristics and performance. Future work should also investigate how to overcome variation inherent to potassium measurement in capillary blood samples, plus investigate barriers and enablers to uptake of self-testing kidney function at home within different patient populations and care pathways.”
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