Summary of findings 2. Low dialysate [Na+] (< 138 mM) versus neutral dialysate [Na+] (138 to 140 mM) for chronic haemodialysis.
| Low dialysate [Na+] (< 138 mM) versus neutral dialysate [Na+](138 to 140 mM) for chronic haemodialysis (HD) | |||||
| Patient or population: chronic HD Setting: dialysis units Intervention: Low dialysate [Na+] (< 138 mM) Comparison: neutral dialysate [Na+] (138 to 140 mM) | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with neutral dialysate [Na+] (138 to 140 mM) | Risk with low dialysate [Na+] (< 138 mM) | ||||
| IDWG | The mean IDWG was 2.55 kg | MD 0.33 kg lower (0.51 lower to 0.14 lower) | ‐ | 263 (6 RCTs) | ⊕⊕⊕⊕ HIGH |
| Intradialytic hypotension | 111 per 1,000 | 165 per 1,000 (121 to 225) | RR 1.49 (1.09 to 2.03) | 12084 (5 RCTs) | ⊕⊕⊕⊝ MODERATE 1 |
| Predialysis MAP | The mean predialysis MAP was 107.1 mmHg | MD 3.52 mmHg lower (5.46 lower to 1.57 lower) | ‐ | 112 (2 RCTs) | ⊕⊕⊝⊝ LOW 2 |
| Postdialysis MAP | The mean postdialysis MAP was 100.82 mmHg | MD 3.01 lower (4.69 lower to 1.34 lower) | ‐ | 112 (2 RCTs) | ⊕⊕⊝⊝ LOW 2 |
| Antihypertensive medication | The mean number of antihypertensive medications was 3.1 | SMD 0.67 SD lower (1.07 lower to 0.28 lower) | ‐ | 103 (2 RCTs) | ⊕⊕⊝⊝ LOW 3 |
| Predialysis serum [Na+] | The mean predialysis serum [Na+] was 138.3 mM | MD 1.59 mM lower (2.4 lower to 0.78 lower) | ‐ | 169 (3 RCTs) | ⊕⊕⊕⊝ MODERATE 4 |
| Intradialytic cramps | 66 per 1,000 | 110 per 1,000 (61 to 197) | RR 1.66 (0.92 to 2.98) | 11700 (4 RCTs) | ⊕⊕⊝⊝ LOW 5 |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio; MD: mean difference; SMD: standardised mean difference IDWG: interdialytic weigh gain; MAP: mean arterial pressure | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
1 Down‐graded because of an era effect in some included studies (indirectness), affecting the applicability to modern settings ‐ see section Overall completeness and applicability of evidence
2 Down‐graded because of low number of studies and patients assessed (imprecision), and the lack of concurrent reporting on antihypertensive medication burden in any study in this analysis
3 Down‐graded because of low number of studies and patients assessed (imprecision)
4 Down‐graded because of only moderate number of studies and patients assessed (imprecision)
5 Down‐graded because of inconsistency between studies, albeit contributed by only one study (Liu 2016), and overall imprecision of effect