Summary of findings 3. Low dialysate [Na+] (< 138 mM) versus high dialysate [Na+] (> 140 mM) for chronic haemodialysis.
| Low dialysate [Na+](< 138 mmol/L) versus high dialysate [Na+] (> 140 mmol/L) for chronic haemodialysis (HD) | ||||||
| Patient or population: chronic HD Setting: dialysis units Intervention: Low dialysate [Na+] (< 138 mmol/L) Comparison: high dialysate [Na+] (> 140 mmol/L) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with high dialysate [Na+] (> 140 mmol/L) | Risk with Low dialysate [Na+] (< 138 mmol/L) | |||||
| IDWG | The mean IDWG was 2.55 kg | MD 0.42 kg lower (0.8 lower to 0.05 lower) | ‐ | 89 (4 RCTs) | ⊕⊕⊕⊝ MODERATE1 | |
| Intradialytic hypotension | 86 per 1,000 | 148 per 1,000 (49 to 438) | RR 1.71 (0.57 to 5.07) | 486 (2 RCTs) | ⊕⊕⊝⊝ LOW2 | |
| Predialysis MAP | The mean predialysis MAP was 98.44 mmHg | MD 4.48 mmHg lower (12.07 lower to 3.1 higher) | ‐ | 44 (2 RCTs) | ⊕⊕⊝⊝ LOW3 | |
| Postdialysis MAP | The mean postdialysis MAP was 101 mmHg | MD 4.85 mmHg lower (9.1 lower to 0.6 lower) | ‐ | 38 (2 RCTs) | ⊕⊕⊝⊝ LOW3 | |
| Antihypertensive medication | see comment | see comment | ‐ | ‐ | ‐ | Not reported |
| Predialysis serum [Na+] | The mean predialysis serum [Na+] was 138.3 mM | MD 1.92 mM lower (3.15 lower to 0.7 lower) | ‐ | 89 (4 RCTs) | ⊕⊕⊕⊝ MODERATE1 | |
| Intradialytic cramps | 255 per 1,000 | 495 per 1,000 (393 to 623) | RR 1.94 (1.54 to 2.44) | 486 (2 RCTs) | ⊕⊕⊝⊝ LOW4 | |
| *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 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 only moderate number of studies and patients assessed (imprecision)
2 Down‐graded because of low number of studies and patients assessed (imprecision), and an era effect in some included studies (indirectness), affecting the applicability to modern settings
3 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
4 Down‐graded because of low number of studies and patients assessed (imprecision)