Table 10.
Summary of GRADE findings
| Intervention | Risk of Bias | Consistency | Imprecision | Indirectness | Publication Bias (No. of Studies) | Quality of Evidence (GRADE) | Comments |
|---|---|---|---|---|---|---|---|
| Phosphate binders | Moderate | Not all RCTs, inconsistent results | None | CKD | 25 | ⊕⊕OO Due to risk of bias and inconsistency | Many studies did not blind participants and investigators |
| Alterations to dialysis prescription | Moderate | Not all RCTs, inconsistent results | None, x-ray | CKD | 8 | ⊕OOO Due to risk of bias, inconsistency, and imprecision | Half used x-ray to assess VC |
| Calcimimetics | High | Not all RCTs, consistent results | None | CKD | 6 | ⊕⊕OO Due to risk of bias and inconsistency | Major study was industry sponsored. Half were non-RCTs |
| Vitamin D | Moderate | Not all RCTs, consistent results | Few participants, x-ray | CKD | 6 | ⊕OOO Due to risk of bias, inconsistency & imprecision | 2 out of 6 were non-RCTs. Half used x-ray to assess VC |
| Exercise | Moderate | RCT | Few participants, x-ray | CKD | 1 | ⊕OOO Due to risk of bias, imprecision, and publication bias | Only 1 study |
| Statins | Moderate | All RCTs, consistent results | Few participants | CKD | 2 | ⊕OOO Due to risk of bias, imprecision, and publication bias | |
| Antiresorptive agents | Moderate | Not all RCTs, inconsistent results | Few participants | CKD | 9 | ⊕ΟΟΟ Due to risk of bias, inconsistency, and imprecision | 4 out of 9 studies were missing information on randomization method and blinding |
| Magnesium | Moderate | Not all RCTs, consistent results | Few participants, x-ray | CKD | 3 | ⊕ΟΟΟ Due to risk of bias, inconsistency, imprecision, and publication bias | |
| Vitamin K | Moderate | All RCTs | None | CKD | 6 | ⊕⊕⊕O Due to risk of bias | |
| Sodium thiosulfate | Moderate | Not all RCTs, consistent results | Few participants | CKD | 7 | ⊕ΟΟΟ Due to risk of bias, inconsistency, imprecision | 3 out of 7 were non-RCTs |
| SNF472 | High | RCT | Few participants | CKD | 1 | ⊕OOO Due to imprecision and publication bias | Only 1 study, which was industry sponsored |
| Spironolactone | Low | RCT | Few participants | CKD | 1 | ⊕⊕OO Due to imprecision and publication bias | Only 1 study |
| Sotatercept | High | RCT | Few participants | CKD | 1 | ⊕ΟΟΟ Due to risk of bias, imprecision, and publication bias | Only 1 study |
| Nicotinamide | Low | RCT | Few participants, x-ray | CKD | 1 | ⊕⊕OO Due to imprecision and publication bias | Only 1 study |
| Oral activated charcoal | Moderate | RCT | Few participants | CKD | 1 | ⊕ΟΟΟ Due to risk of bias, imprecision, and publication bias | Only 1 study |
All interventions were compared with placebo, control, or another comparator, with VC as the outcome. High quality ⊕⊕⊕⊕; moderate quality ⊕⊕⊕O; low quality ⊕⊕OO; very low quality ⊕ΟΟΟ.