Background: Physical exercise is a potential non-pharmacological therapy for patients with end-stage renal disease (ESRD). Perception of benefits and barriers of exercise among hemodialysis (HD) patients is linked with their exercise behavior. This study aimed to investigate perceptions of exercise benefits and barriers among patients on HD in Saudi Arabia and their associated predictors. Methods: This is a cross-sectional survey study that was conducted in two dialysis centers in Saudi Arabia between May and September 2025. In this research, the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS) was used to examine patients’ perceived benefits and barriers to exercise. Patients’ physical activity status was evaluated using the General Practice Physical Activity Questionnaire (GPPAQ). Multivariate logistic regression analysis was used to define factors influencing positive perception towards physical activities and perceived barriers. Results: This study included 104 patients with ESRD. Most patients expressed positive perceptions regarding the benefits of exercise. The majority agreed or strongly agreed that exercise improves mood (87.5%), prevents muscular atrophy (81.8%), postpones decline in body function (81.7%), and enhances quality of life (83.7%). Regarding barriers to exercise, several concerns were frequently reported by patients. The most prominent barrier was worry about affecting the arteriovenous fistula. Tiredness (70.2%) and muscle fatigue (63.5%) were also commonly cited obstacles. Age was significantly associated with lower odds of perceiving exercise as beneficial (aOR = 0.94; 95%CI:0.91–0.98; p = 0.008). This indicates that older patients were slightly less likely to report a positive perception towards exercise. Having a bachelor’s degree is associated with higher odds of reporting exercise barriers compared with no education (aOR = 16.22, 95%CI:1.29–204.42; p = 0.03). The majority of the patients (78.8%) are classified as physically inactive. Conclusions: This study revealed that most patients on HD in Saudi Arabia have positive perceptions regarding the benefits of exercise. Nevertheless, several barriers were also reported by these patients, with tiredness, worry about affecting the arteriovenous fistula, body pain, and muscle fatigue being the most reported barriers. Further studies are necessary to investigate the relationship between a positive perception of exercise benefits and exercise engagement.

Background: Chronic obstructive pulmonary disease (COPD) is a significant burden in Saudi Arabia. Improving the attitudes, awareness, and knowledge of healthcare providers toward advance directives and/or advanced care planning (ACP) can increase the use of advance directives. This study aims to investigate healthcare providers’ knowledge, attitudes, and practices concerning advance directives for COPD patients in Riyadh, Saudi Arabia. Methods: This cross-sectional study was employed to assess the knowledge, attitudes, and practices of healthcare providers towards ACP for COPD patients in Riyadh between June and December 2024. The questionnaire was adapted from previous research. Multiple logistic regression was performed to assess the factors associated with good knowledge and positive attitude. Results: A total of 268 participants were included in the analysis. The total mean of knowledge score was 6.96 ± 2.22 out of 12. A total of 161 participants (60.1%) had a poor knowledge score, and 107 participants (39.9%) had a good knowledge score. The total mean of attitude score was 16.23 ± 23.21 out of 26. A total of 148 participants (55.2%) had a poor attitude score and 120 participants (44.8%) had positive attitude. Participants with over 15 years of experience exhibited significantly higher odds of good knowledge (OR = 6.76, 95% CI = 1.03−44.21, p = 0.04). Participants who lived in the Western region had significantly lower odds of good knowledge (OR = 0.32, 95% CI = 0.14–0.71, p = 0.005). Nurses and respiratory therapists had significantly lower odds of having positive attitude (OR = 0.19, 95% CI = 0.09−0.42, p = 0.0001 and OR = 0.34, 95% CI = 0.16–0.75, p = 0.007, respectively). Participants who lived in the Western region had significantly lower odds of having positive attitude (OR = 0.42, 95% CI = 0.19–0.95, p = 0.005). Conclusions: Healthcare providers in Saudi Arabia demonstrated a moderate level of knowledge of ACP for COPD patients. This was accompanied by a moderately positive attitude towards this practice. Future studies should examine effective educational and professional interventions to enhance ACP practices.

Mineralocorticoid receptor (MR) overactivation is a key driver of inflammation, fibrosis, and organ cross-talk across cardiorenal disease. Finerenone, a selective non-steroidal MR antagonist, has demonstrated robust renoprotective and cardioprotective benefits in patients with chronic kidney disease (CKD) and type 2 diabetes in large randomized clinical trials. Beyond its established role in diabetic kidney disease, emerging preclinical and clinical data suggest potential systemic effects through the attenuation of MR-driven inflammatory and fibrotic pathways. These include signals related to heart failure outcomes, atrial remodeling, pulmonary vascular biology, retinal microvascular integrity, and metabolic dysfunction. However, much of the evidence beyond established cardiorenal indications remains exploratory, based on preclinical studies, subgroup analyses, and post hoc evaluations. This review provides a critical synthesis of the established clinical evidence supporting finerenone in CKD and cardiovascular disease. It examines emerging, hypothesis-generating data regarding its potential systemic effects beyond diabetic kidney disease.