Table.
GRADE evaluation of interventions for acute renal failure
| Important outcomes | Kidney injury, mortality, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of interventions to prevent acute renal failure in people at high risk? | |||||||||
| 31 (5146) | Kidney injury | Low-osmolality contrast media v high-osmolality contrast media | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 2 (365) | Kidney injury | Intravenous sodium chloride 0.9% v oral fluids | 4 | 0 | −1 | 0 | 0 | Moderate | Consistency point deducted for conflicting results |
| 1 (1620) | Kidney injury | Sodium chloride 0.9% v sodium chloride 0.45% | 4 | 0 | 0 | 0 | 0 | High | |
| 1 (45) | Kidney injury | Sodium chloride 0.45% v restricted fluids | 4 | −1 | 0 | −1 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (36) | Kidney injury | Inpatient v outpatient fluid regimens | 4 | −2 | 0 | −2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness points deducted for differences in amount of fluids administered and uncertainty about clinical relevance of outcome measured |
| 17 (2201) | Kidney injury | Acetylcysteine v control in the prevention of contrast nephropathy | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for incomplete reporting of results. Consistency point deducted for heterogeneity between RCTs and added for dose response. Directness point deducted for differences in timing and dose administration |
| 1 (354) | Mortality | Acetylcysteine v control in the prevention of contrast nephropathy | 4 | 0 | +1 | −1 | 0 | High | Consistency point added for dose response. Directness point deducted for composite outcome |
| 2 (337) | Kidney injury | Acetylcysteine v placebo in the prevention of perioperative acute renal failure | 4 | 0 | 0 | 0 | 0 | High | |
| 1 (142) | Kidney injury | Acetylcysteine v placebo in the prevention of acute renal failure after hypotension | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 2 (420) | Kidney injury | Iso-osmolar contrast media v low osmolar contrast media | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for not using standardised volumes of contrast media or fluid regimens |
| 4 (803) | Kidney injury | Single-dose aminoglycosides v multiple doses | 4 | −1 | −1 | 0 | 0 | Low | Quality point deducted for incomplete reporting of results. Consistency point deducted for different results for people with different disease severities |
| 1 (119) | Kidney injury | Sodium bicarbonate v sodium chloride | 4 | −2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and no intention-to-treat analysis |
| 3 (770) | Kidney injury | Fenoldopam v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 3 (770) | Mortality | Fenoldopam v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 2 (180) | Kidney injury | Fenoldopam v dopamine | 4 | −2 | −1 | 0 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Consistency point deducted for conflicting results |
| 11 (1094) | Kidney injury | Fenoldopam v other treatments or control | 4 | −3 | −1 | −1 | 0 | Very low | Quality points deducted for incomplete reporting of results and methodological weaknesses. Consistency point deducted for heterogeneity between RCTs. Directness point deducted for heterogenous combined control |
| 1 (78) | Kidney injury | Mannitol plus intravenous fluids v intravenous fluids | 4 | −1 | 0 | −1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for multiple comparisons |
| 2 (206) | Kidney injury | Renal replacement therapy (haemofiltration) v isotonic saline | 4 | −1 | 0 | −2 | 0 | Very low | Quality point deducted for methodological weaknesses. Directness points deducted for differences in treatments provided to both groups and for uncertainty about benefit |
| 1 (114) | Mortality | Renal replacement therapy (haemofiltration) v isotonic saline | 4 | −2 | 0 | −2 | 0 | Very low | Quality points deducted for sparse data and methodological weaknessess. Directness points deducted for differences in treatments provided to both groups |
| 7 (480) | Kidney injury | Theophylline or aminophylline v control in radiocontrast-induced nephropathy | 4 | −2 | −1 | −1 | 0 | Very low | Quality points deducted for incomplete reporting of results and uncertainty about hydration status of people receiving radiocontrast agent and for uncertainty about heterogeneity between studies. Directness point deducted for uncertainty about clinical significance |
| 1 (56) | Kidney injury | Theophylline v sodium chloride 0.9% after CABG | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (210) | Kidney injury | Calcium channel blockers v placebo in people receiving live or cadaveric kidney transplant | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 7 (349) | Kidney injury | Calcium channel blockers v no calcium channel blockers in people receiving cadaveric kidney transplant | 4 | −2 | −1 | 0 | 0 | Very Low | Quality points deducted for incomplete reporting of results and for not reporting loss to follow-up or duration. Consistency point deducted for heterogeneity between RCTs |
| 5 (284) | Mortality | Calcium channel blockers v no calcium channel blockers in people receiving cadaveric kidney transplant | 4 | −2 | −1 | 0 | 0 | Very Low | Quality points deducted for incomplete reporting of results and for not reporting loss to follow-up or treatment duration. Consistency point deducted for heterogeneity between RCTs |
| at least 10 RCTs (at least 618 people) | Kidney injury | Dopamine v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 12 (832) | Mortality | Dopamine v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 3 (255) | Kidney injury | Loop diuretics v fluids alone | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for differences in treatment protocols |
| 2 (202) | Mortality | Loop diuretics v fluids alone | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for differences in treatment protocols |
| 2 (3067) | Kidney injury | Natriuretic peptides v placebo | 4 | −1 | −1 | −2 | 0 | Very low | Quality point deducted for incomplete reporting of results. Consistency point deducted for conflicting results. Directness points deducted for composite outcome and for using low doses and long treatment durations |
| What are the effects of treatments for critically ill people with acute renal failure? | |||||||||
| 2 (531) | Mortality | High-dose continuous renal replacement therapy v low-dose continuous renal replacement therapy | 4 | 0 | 0 | –1 | 0 | Moderate | Consistency point added for dose response but deducted for conflicting results. Direcntess point deducted for comparing people with different disease severities |
| 1 (206) | Mortality | Haemofiltration v haemofiltration plus dialysis | 4 | 0 | 0 | 0 | 0 | High | |
| 6 (624) | Kidney injury | Renal replacement therapy (continuous) v intermittent renal haemodialysis | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 6 (624) | Mortality | Renal replacement therapy (continuous) v intermittent renal haemodialysis | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 1 (360) | Mortality | Renal replacement therapy (intermittent haemodialysis) v continuous veno-venous haemodiafiltration | 4 | 0 | 0 | −1 | 0 | Moderate | Directness point deducted for uncertainty about applicability to usual practice |
| 7 + 15 studies (1589) | Mortality | Dialysis membranes (synthetic) v cellulose-based | 4 | −3 | −1 | 0 | 0 | Very low | Quality points deducted for incomplete reporting of results, methodological weaknesses, and for including non-RCTs. Consistency point deducted for conflicting results |
| at least 2 RCTs (at least 422 people) | Kidney injury | Loop diuretics v control | 4 | −3 | 0 | 0 | 0 | Very low | Quality points deducted for poor reporting and methodological weaknesses |
| 5 (at least 574 people) | Mortality | Loop diuretics v control | 4 | −3 | 0 | 0 | 0 | Very low | Quality points deducted for poor reporting and methodological weaknesses |
| 10 (618) ) | Kidney injury | Dopamine v placebo | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for inclusion of trials |
| 1 RCT + 11 trials (832) | Mortality | Dopamine v placebo | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for inclusion of trials |
| 3 (900) | Kidney injury | Natriuretic peptides v placebo | 4 | −1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
Type of evidence: 4 = RCT; 2 = Observational Consistency: similarity of results across studies Directness: generalisability of population or outcomes Effect size: based on relative risk or odds ratio