The primary reasons patients use CVCs are "non-medical" followed by concerns with the complications and esthetic appearance associated with fistulas/grafts. The significant discordance between the reasons the patients give and the VAC's view of patient reasons for CVC use suggests a gap in knowledge, understanding, or communication between patients and their VACs. Timely predialysis education to address this gap and realistic targets are necessary to reduce CVC prevalence.

IntroductionChronic kidney disease (CKD) is often accompanied by complications including poor physical activity level. However, only a few studies have objectively characterized physical activity levels in predialysis CKD. Our study sought to measure daily activity levels by accelerometry in individuals with CKD (stages III−V) and to determine the association between daily activity and kidney function.MethodsWe determined kidney function by means of the estimated glomerular filtration rate (eGFR) using the Modification of Diet and Renal Disease (MDRD) equation. Participants wore an accelerometer for 7 consecutive days, and we measured multiple physical activity outcomes including total daily activity, sedentary, light, and moderate−vigorous activity. Average durations and intensity of activity were determined according to stage of CKD. The association between kidney function and activity level was determined by regression analysis.ResultsWe analyzed data from 110 individuals (60% men and 40% women) with stages III to V CKD. The mean age of our participants was 64 years, mean body mass index was 27.5 kg/m2, and mean eGFR was 23.7 ± 1.2 ml/min/1.73 m2. Our participants were primarily sedentary (mean duration of inactivity = 1152 ± 100 minutes per day; 79% of day). Light activity was performed 280 ± 99 minutes per day, and individuals participated in only 6 ± 9 minutes per day of moderate−vigorous activity. The eGFR did not predict physical activity level (P > 0.05 for all).DiscussionIndividuals with stages III to V CKD are sedentary, and do not meet the national recommendations of 150 minutes of moderate−vigorous activity per week. Further study is required to determine whether interventions to increase activity levels in patients with CKD are associated with improved health outcomes.

Anxiety is a complex emotional condition that is often described as a noxious internal disturbance that is accompanied by restlessness. Objectives: To determine the prevalence of preoperative anxiety and to find out main risk factors among patients waiting for open heart surgery. Methods: A cross-sectional study was carried out at cardiac centers of Rawalpindi. A total of 180 respondents who were admitted in hospital for open heart surgery were consecutively selected for the purpose of the study. APAIS and STAI were used to collect data regarding preoperative anxiety. Adjusted odd ratios were determined for the major risk factors. Results: Majority were males (64.4%) and were 20-46 years of age (48.3%). It can be seen that patients who presented low levels of preoperative anxiety were slightly higher in number as compared to those who presented high levels of anxiety. Females, patients of younger age group (20-46 years) and those undergoing valvular surgeries were more prone to develop all subtypes of preoperative anxiety (p value<0.05). While surgery schedule is also a main predictor of anxiety due to anaesthesia and procedure (p value<0.05). Conclusions: Majority of the patients undergoing open heart surgery presented low levels of preoperative anxiety while females, younger patients and those undergoing valvular surgeries were considered more susceptible of developing preoperative anxiety.