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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.