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Table 3 GRADE evidence profile table: citrate vs. heparin locking solutions for hemodialysis catheters

From: Benefits and harms of citrate locking solutions for hemodialysis catheters: a systematic review and meta-analysis

Quality assessment

№ of patients

Effect

Quality

Importance

№ of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Citrate

heparin

Relative (95% CI)

Absolute (95% CI)

Survival (follow up: range 56,428 Total Catheter Days)

3

randomised trials

not serious

not serious

not serious

very serious 1

none

22/312 (7.1%)

28/272 (10.3%)

RR 0.71 (0.42 to 1.21)

30 fewer per 1000 (from 22 more to 60 fewer)

LOW

CRITICAL

Bacteremia (follow up: range 56,428 Total Catheter Days)

3

randomised trials

not serious

serious 2

not serious

serious 3

none

27/312 (8.7%)

51/272 (18.8%)

Rate Ratio 0.54 (0.23 to 1.29)

0 fewer per 1000 (from 0 fewer to 0 fewer) 9

LOW

CRITICAL

Thrombolysis (follow up: range 56,428 Total Catheter Days)

3

randomised trials

not serious

serious 4

not serious

serious

none

235/172 (136.6%)

150/180 (83.3%)

Rate Ratio 1.25 (0.76 to 2.05)

0 fewer per 1000 (from 0 fewer to 0 fewer)

LOW

IMPORTANT

Bleeding (follow up: range 20,320 Total Catheter Days)

2

randomised trials

not serious

not serious

not serious

serious 5

none

30/180 (16.7%)

53/172 (30.8%)

Rate Ratio 0.48 (0.30 to 0.75)

0 fewer per 1000 (from 0 fewer to 0 fewer)

MODERATE

IMPORTANT

Hospitalization for any reason (follow up: range 52,338 Total Catheter Days)

2

randomised trials

not serious

serious 6

not serious

serious 7

none

23/280 (8.2%)

33/243 (13.6%)

Rate Ratio 0.68 (0.38 to 1.20)

0 fewer per 1000 (from 0 fewer to 0 fewer)

LOW

IMPORTANT

Catheter replacement for patency (follow up: range 24,410 Total Catheter Days)

3

randomised trials

not serious

not serious

not serious

serious 8

none

36/190 (18.9%)

35/182 (19.2%)

Rate Ratio 0.94 (0.59 to 1.50

0 fewer per 1000 (from 0 fewer to 0 fewer)

MODERATE

IMPORTANT

  1. MD – mean difference, RR – relative risk.
  2. 1Studies not powered for survival outcome; optimal information siz e criterion not met.
  3. 2I2=65% for pooled effect estimate; could not exclude heterogeneity due to study design, duration of follow-up, and citrate concentration.
  4. 3Overall event rates were low; studies were likely underpowered to detect statistically significant differences in bacteremia.
  5. 4I2=77% for pooled effect estimate, possibly due to unexplained heterogeneity in outcome definitions and study design.
  6. 5Vary small event rate and sample siz e; observed effect may be due to random error.
  7. 6I2=86% using fixed-effect model; unexplained heterogeneity exists.
  8. 7Confidence interval includes no effect.
  9. 8Optimal information siz e criterion not met.
  10. 9No explanation was provided.