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Aim: This study aimed to investigate personal preparedness among patients on haemodialysis (HD) and to examine the relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours during natural disaster incidents. Design: A cross‐sectional survey was conducted. Methods: A convenience sampling method was used. A total of 446 participants from six areas of Sichuan province completed the online questionnaire study from February 27 to March 13, 2022. Sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were measured. Descriptive statistics were used to analyse sociodemographic characteristics and attitudes toward disaster preparedness. The relationship among sociodemographic characteristics, attitudes toward disaster preparedness and personal preparedness behaviours were assessed using ordinal regression. Statistical significance was defined as p < 0.05. Results: A total of 446 participants completed the survey. Of these, 42.15% (N = 188) were poorly prepared, 26.23% (N = 117) were moderately prepared and 31.61% (N = 141) were highly prepared. Ordinal regression showed that knowing about disaster preparedness (Odds Ratio (OR) = 1.691, 95% Confidence Interval (CI) = 1.081–2.644, p = 0.021), participating in disaster evacuation exercises (OR = 2.519, 95% CI = 1.595–3.977, p < 0.001) and learning about disaster preparedness (OR = 2.421, 95% CI = 1.542–3.802, p < 0.001) were associated with high preparedness. Compared to patients with a university degree or higher, patients with a junior high school education or lower (OR = 3.491, 95% CI = 1.760–6.925, p < 0.001) and senior high school degree (OR = 2.052, 95% CI = 1.038–4.057, p = 0.039) were associated with high preparedness. Patients who felt very confident and could deal with all their needs (OR = 3.878, 95% CI = 2.904–7.181, p < 0.001) or patients who felt confident and could meet some of their needs (OR = 1.949, 95% CI = 1.124–3.379, p = 0.017) had higher preparedness than those who felt less confident and were not well prepared to take care of their needs. Patient or Public Contribution: After obtaining each participant's consent, they filled out the online questionnaire using their own or a relative's cell phone while undergoing HD. Implication for Practice: It is essential that patients should be educated not only on medical specialty topics, but also on general disaster preparedness. Medical institutions should improve and reinforce preparation training among targeted populations. The low level of preparedness is partly due to the lack of participation of patients in disaster preparedness programs. Dialysis center managers should be urged to implement such programs at their centers. [ABSTRACT FROM AUTHOR]

Background and objective: End‐stage renal disease (ESRD) affects a multitude of aspects in the patient's daily life, often entailing their own involvement in various aspects of the treatment. Although patient participation is a core health‐care value, what the concept signifies is not yet fully known. The purpose of this paper is to conceptualize patient participation in dialysis care, depicting patients' and health‐care professionals' perspectives. Design: This explorative study employed qualitative interviews and content analysis. Setting and participants: Seven focus group discussions engaging 42 key informants were performed, including patients, staff and managers with experience of dialysis care. Results: In dialysis care, patient participation connotes a sharing of information and knowledge, the learning of and planning of care, including partaking in shared decisions with regards to treatment and management, and being involved in the management of one's own health‐care treatment and/or self‐care activities. Although these attributes were illustrated by all stakeholders, their significance varied: patients suggested that their preferences regarding primary aspects of participation vary, while staff considered patients' performance of dialysis to be the ultimate form of participation. Further, while patients considered multiple ways to execute participation, staff suggested that aspects such as sharing information were a route to, rather than actual, involvement. Conclusions: Without a common understanding to denote the idea of patient participation, staff and patients are exposed to a potential deficit in terms of facilitating patient participation in everyday encounters of dialysis treatment. Further studies and means to serve a mutual understanding are needed. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage kidney disease on haemodialysis suffer from frequent complications requiring hospitalisation. Atrial fibrillation is a burdensome comorbidity amongst patients on haemodialysis. We aimed to assess frequency, reasons, and duration of hospitalisations in haemodialysis patients and their association with atrial fibrillation and anticoagulation. Methods: Prevalent patients with end-stage kidney disease on haemodialysis were recruited into a prospective cohort study and observed for a median observation time of 3.4 years. Hospitalisations were recorded from discharge letters, medical records, and patient interviews. The association of atrial fibrillation, anticoagulation, and time-in-therapeutic range of vitamin K antagonist treatment with hospitalisations was analysed using negative binomial regression. Results: Out of 625 patients, 238 (38.1%) had atrial fibrillation. Median number of hospitalisations per patient was 3.0 (1.0–5.0). Incidence rate of hospitalisation was 1.7 per patient-year in all and 1.9 in atrial fibrillation patients, median duration per hospitalisation was 7.9 (4.8–12.9) and 8.8 (5.7–13.3) days, respectively. Most frequent reasons for hospitalisation were vascular access complication/intervention (11.7%) and infection/fever (11.4%), while bleeding events comprised 6.0% of all hospitalisations. Atrial fibrillation patients had 27% higher risk of hospitalisation than patients without atrial fibrillation (incidence rate ratio [IRR] 1.27, 95% confidence interval [CI] 1.10–1.47). In atrial fibrillation patients, anticoagulation (enoxaparin or phenprocoumon, 41.6% of AF patients) was associated with increased risk of all-cause (IRR 1.38, 95%CI 1.14–1.69) and bleeding-related hospitalisation (IRR 1.96, 95%CI 1.06–3.63). There was no association between anticoagulation and stroke-related hospitalisation. In atrial fibrillation patients on phenprocoumon, increasing time-in-therapeutic range was associated with decreased risk of all-cause (IRR 0.35, 95%CI 0.14–0.87), but not bleeding-related hospitalisation (IRR 0.13, 95%CI 0.01–1.38). Conclusion: In haemodialysis patients, presence of atrial fibrillation and, among those with atrial fibrillation, anticoagulation were associated with higher risk of all-cause hospitalisation, including bleeding-related hospitalisation in the latter. Increasing time-in-therapeutic range in patients on vitamin K antagonist treatment was associated with decreased risk of all-cause, but not bleeding-related hospitalisation. [ABSTRACT FROM AUTHOR]

Background/Objectives: An increase in fat mass is accompanied by a loss of muscle mass and function in chronic kidney disease. However, no studies in haemodialysis (HD) patients have investigated the relationship between fat mass and sarcopenia. The primary aim of this study is to assess the prevalence of sarcopenia, while the secondary aim is to verify the association between the fat mass percentage and SARC-F and SARC-F combined with calf circumference (SARC-F+CC) in elderly HD patients. Subjects/Methods: A cross-sectional study enrolled 96 HD older patients (male, n = 66). SARC-F ≥4 is used to define the muscle function loss, whereas SARC-F ≥6 or SARC-F ≥11 (with the calf circumference added) are the thresholds to diagnose sarcopenia. The fat mass percentage is obtained using bioelectrical impedance analysis. Results: We found that 37.5% had a risk of muscle function loss due to SARC-F ≥4, 21.8% risk of sarcopenia using the SARC-F ≥6, and when using CC, the prevalence of risk of sarcopenia increased to 41.6% according to SARC-F+CC ≥11. In addition, there was an association between adiposity and sarcopenia for SARC-F ≥6 (OR: 1.25, p= 0.028) and SARC-F+CC ≥11 (OR: 1.25, p= 0.0003), but not with muscle function loss (SARC-F ≥4). Conclusion: In conclusion, we found that 37.5% of HD patients had a risk of muscle function loss and 21–41% presented sarcopenia, depending on the cut-off point used. In addition, higher adiposity was associated with an increased likelihood of having sarcopenia by 25%. [ABSTRACT FROM AUTHOR]

Background: Chinese herbal bath therapy (CHBT) is a traditional external therapy that has been used for the treatment of uremic pruritus (UP) in China. We conducted a meta-analysis to evaluate the efficacy and safety of CHBT for UP. Methods: We searched seven databases for studies published since database inception to September 1, 2018. Randomized trials evaluating CHBT for UP were collected. The therapeutic effects of CHBT were measured by the pruritus level (via the visual analogue scale (VAS) or the symptom score scale) and the total effective rate. We combined studies using mean difference (MD) for continuous outcomes and using risk ratio for dichotomous data, both with 95% confidence intervals. RevMan V.5.3 software was used to assess the data reported and perform the meta-analysis. Results: Seventeen articles including 970 patients were identified. All participants were haemodialysis (HD) patients. CHBT is administered by immersing the whole body in a prepared herbal water bath. On average, an herbal bath prescription included 11 Chinese herbs. The mean treatment duration was 4.7 weeks. Compared with basic treatment (HD or haemoperfusion (HP)) and adding a control of sham CHBT, clear hot water bath, or calamine lotion, CHBT plus basic treatment reduced the VAS score (MD = − 2.38; 95% confidence intervals [CI], − 3.02 to − 1.74; P < 0.00001) and the symptom score (MD = − 8.42; 95% confidence intervals [CI], − 12.47 to − 4.36; P < 0.00001) and had a higher total effectiveness rate (risk ratio [RR] = 1.46; 95% CI, 1.31 to 1.63; P < 0.00001). Conclusions: In conclusion, CHBT could be a complementary therapy for improving pruritic symptoms in uraemia patients. More rigorously designed, multicentre, prospective RCTs are warranted to further identify the efficacy and safety of CHBT. Trial registration: Systematic review registration: [PROSPERO registration: CRD42018108506]. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of Mg administration on carotid intima–media thickness (CIMT), glycaemic control and markers of cardio-metabolic risk in diabetic haemodialysis (HD) patients. This randomised, double-blind, placebo-controlled clinical trial was conducted in fifty-four diabetic HD patients. Participants were randomly divided into two groups to take either 250 mg/d Mg as magnesium oxide (n 27) or placebo (n 27) for 24 weeks. Mg supplementation resulted in a significant reduction in mean (P <0·001) and maximum levels of left CIMT (P =0·02) and mean levels of right CIMT (P =0·004) compared with the placebo. In addition, taking Mg supplements significantly reduced serum insulin levels (β =–9·42 pmol/l; 95% CI –14·94, –3·90; P =0·001), homoeostasis model of assessment-insulin resistance (β =–0·56; 95 % CI –0·89, –0·24; P =0·001) and HbA1c (β =–0·74 %; 95 % CI –1·10, –0·39; P <0·001) and significantly increased the quantitative insulin sensitivity check index (β =0·008; 95 % CI 0·002, 0·01; P =0·002) compared with the placebo. In addition, Mg administration led to a significant reduction in serum total cholesterol (β =–0·30 mmol/l; 95% CI –0·56, –0·04; P =0·02), LDL-cholesterol (β =–0·29 mmol/l; 95% CI –0·52, –0·05; P =0·01), high-sensitivity C-reactive protein (hs-CRP) (P <0·001) and plasma malondialdehyde (MDA) (P =0·04) and a significant rise in plasma total antioxidant capacity (TAC) levels (P <0·001) compared with the placebo. Overall, we found that taking Mg for 24 weeks by diabetic HD patients significantly improved mean and maximum levels of left and mean levels of right CIMT, insulin metabolism, HbA1c, total cholesterol and LDL-cholesterol, hs-CRP, TAC and MDA levels. [ABSTRACT FROM AUTHOR]

Background Haemodialysis patients receive very little involvement in their end-of-life care decisions. Issues relating to death and dying are commonly avoided until late in their illness. This study aimed to explore the experiences and perceptions of doctors and nurses in nephrology for involving haemodialysis patients in end-of-life care decisions. Methods A semi-structured qualitative interview study with 15 doctors and five nurses and thematic analysis of their accounts was conducted. The setting was a large teaching hospital in Wales, UK. Results Prognosis is not routinely discussed with patients, in part due to a difficulty in estimation and the belief that patients do not want or need this information. Advance care planning is rarely carried out, and end-of-life care discussions are seldom initiated prior to patient deterioration. There is variability in end-of-life practices amongst nephrologists; some patients are felt to be withdrawn from dialysis too late. Furthermore, the possibility and implications of withdrawal are not commonly discussed with well patients. Critical barriers hindering better end-of-life care involvement for these patients are outlined. Conclusions The study provides insights into the complexity of end-of-life conversations and the barriers to achieving better end-of-life communication practices. The results identify opportunities for improving the lives and deaths of haemodialysis patients. [ABSTRACT FROM AUTHOR]