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