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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.

BackgroundAccurate prognosticating is needed when patients are nearing the end of life to ensure appropriate treatment decisions, and facilitate palliative care provision and transitioning to terminal care. People with a hematological malignancy characteristically experience a fluctuating illness trajectory leading to difficulties with prognosticating. The aim of this review was to identify current knowledge regarding ‘bedside’ prognostic factors in the final 3 months of life for people with a hematological malignancy associated with increased risk of mortality.MethodsA systematic review of the literature was performed across: PubMed; CINAHL; PsycINFO; and Cochrane with set inclusion criteria: 1) prognostic cohort studies; 2) published 2004–2014; 3) sample ≥ 18 years; 4) >50% sample had a hematological malignancy; 5) reported ‘bedside’ prognostic factors; 6) median survival of <3 months; and 7) English language. Quality appraisal was performed using the Quality In Prognostic Studies (QUIPS) tool. Results are reported in line with PRISMA guidelines.ResultsThe search returned 4860 studies of which 28 met inclusion criteria. Twenty-four studies were rated moderate quality, three were high quality and one study was deemed to be of low quality. Most studies were set in the ICU (n = 24/28) and were retrospective (n = 25/28). Forty ‘bedside’ prognostic factors were identified as associated with increased risk of mortality encompassing the following broad categories: 1) demographics; 2) physiological complications or conditions; 3) disease characteristics; 4) laboratory blood values; and 5) interventions.ConclusionsThe literature on prognosticating in the final months of life was predominantly focused on people who had experienced acute physiological deterioration and were being treated aggressively in the in-patient setting. A significant gap in the literature exists for people who are treated less aggressively or are on a palliative trajectory. Findings did not report on, or confirm the significance of, many of the key prognostic factors associated with increased risk of mortality at the end of life in the solid tumour population, demonstrating key differences in the two populations.Trial registrationThis systematic review was not registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3207-7) contains supplementary material, which is available to authorized users.

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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.