A. (2020). The relationship between chronic kidney disease, symptoms and healthrelated quality of life: a systematic review. Journal of Renal Care 46(2), 74-84. S U M M A R YBackground: People with chronic kidney disease (CKD) experience a wide range of symptoms due to reduced kidney function. As the disease progresses these symptoms become more burdensome and often negatively affect a person's health-related quality of life (HRQoL). Objective: To examine the evidence of symptoms and HRQoL in CKD stages 1-5 and the relationships between these. Methods: Studies published in English from January 2008 to July 2018 using six databases (PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Library and JBI Library) were searched. Results: Thirteen studies were included in this review although only three had interventional designs. By considering symptom experience and HRQoL together, four studies found that HRQoL decreased when symptoms increased. Feeling washed out, fatigue and drowsiness were found to be the most common symptoms reported. Only two studies reported follow-up measurements although six studied how symptoms change over time. None of the studies examined the change of symptoms over time across the different CKD stages. The majority of studies showed a decline in physical HRQoL and improvement in mental HRQoL over time. Nutritional and exercise interventions showed some improvements in symptom experience and HRQoL. Conclusions: Only four studies were found that reported the relationship between symptoms and HRQoL of those with CKD. Of these, in view of symptom experience and HRQoL together, HRQoL decreased when symptoms increased. However, more research is warranted to establish a clear understanding of the relationship between symptoms and HRQoL in CKD to enable the design of appropriate interventions.

Aims and objectives To compare symptoms and health‐related quality of life and to examine the relationship between these as kidney function deteriorates. Background Chronic kidney disease is a global health problem, and while knowledge of symptom burden and health‐related quality of life is understood in kidney failure (previously end‐stage kidney disease), there is limited understanding about symptoms and health‐related quality of life across the chronic kidney disease trajectory. Design Cross‐sectional design reported using the STROBE guidelines. Methods Eight hundred eighty‐six adults with varying levels of kidney function (chronic kidney disease grades 3b–5 including those receiving dialysis) completed the renal version of the Integrated Palliative care Outcome Scale and the Quality of Life Short Form‐36 version 2. Socio‐demographic and renal characteristics were also collected. Data were analysed using descriptive and inferential statistics. Results Participants had a mean age of 57 years and were mostly male. Regardless of chronic kidney disease grade, pain, poor mobility, weakness, anxiety and depression were the most prevalent and severe symptoms reported. Health‐related quality of life was significantly associated with physical and psychological symptom scores. As kidney function deteriorated, both physical and mental health‐related quality of life decreased, and prevalence and severity of symptoms increased. Conclusions There is substantial symptom burden irrespective of chronic kidney disease grade, which overwhelmingly affects health‐related quality of life. Early identification by nurses would enable proactive management plans to be implemented. Relevance to clinical practice Nurses, whether in specialist renal services or in primary healthcare, are ideally placed to regularly assess symptoms and health‐related quality of life in those with chronic kidney disease. Timely assessment could assist in the targeting of earlier interventions designed to reduce symptom burden and to increase health‐related quality of life.

Dengue, chikungunya and Zika viruses share similar disease features, rendering them difficult to distinguish clinically. Incapacitating arthralgia/arthritis is a specific manifestation associated with chikungunya virus infection. However, the profile of arthralgia/arthritis in Zika virus (ZIKV) cases has not been well characterized. Articles were extracted from PubMed and Scopus databases reporting original data from patients with arthralgia/arthritis, according to the Cochrane Collaboration. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 137 articles reporting ZIKV-associated joint symptoms were reviewed. Arthralgia was more frequently reported (n = 124 from case studies, n = 1779 from population-based studies) than arthritis (n = 7 and n = 121, respectively). Arthralgia was resolved in <1 week in 54%, and within 1–2 weeks in 40% of cases. The meta-analysis of cases in population-based studies identified a pooled prevalence of 53.55% for arthralgia. The pooled prevalence of arthralgia/arthritis during outbreaks depended on the geographic location, with a higher joint symptom burden observed in the Americas compared to South East Asia (Brazil: 60.79%; Puerto Rico: 68.89% and South East Asia: 26.46%). We conclude that non-specific constitutional arthralgia is the most common joint manifestation during ZIKV infection, being present in nearly half of cases but resolving by two weeks in >90% of these. We found no evidence of chronic rheumatic manifestations following ZIKV infection.