Acute kidney injury
Evidencia
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Tablas de evidencia del BMJ Best Practice
Las tablas de evidencia proporcionan capas de evidencia de fácil navegación en el contexto de preguntas clínicas específicas, utilizando GRADE y una clasificación de eficacia de las BMJ Best Practice. Siga los enlaces de la parte inferior de la tabla, que van a la puntuación de la evidencia relacionada en el texto del tema principal, proporcionando un contexto adicional para la pregunta clínica. Conozca más sobre nuestras tablas de evidencia.
Esta tabla es un resumen del análisis que figura en una directriz (respaldada por una revisión sistemática) que se centra en la importante cuestión clínica arriba citada.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Población: Adults who are at risk of CI-AKI
Intervención: Sodium chloride 0.9%
Comparación: No intravenous hydration, oral fluids, sodium chloride 0.45%, sodium bicarbonate, oral sodium bicarbonate plus oral fluids
| Resultado | Eficacia (clasificación BMJ)? | Confianza en las evidencias (GRADE)? |
|---|---|---|
Sodium chloride 0.9% versus no intravenous hydration | ||
CI-AKI | No statistically significant difference | Low |
In-hospital mortality | No statistically significant difference | Very Low |
All-cause mortality | No statistically significant difference | Low |
Need for renal replacement therapy: dialysis | No statistically significant difference | Low |
Adverse events | No statistically significant difference | Very Low |
Sodium chloride 0.9% versus oral fluids | ||
CI-AKI | No statistically significant difference | Very Low |
All-cause mortality | No statistically significant difference | Very Low |
Need for renal replacement therapy: dialysis | No statistically significant difference | Very Low |
Sodium chloride 0.9% versus sodium chloride 0.45% | ||
CI-AKI | No statistically significant difference | Very Low |
Mortality | No statistically significant difference | Very Low |
Need for renal replacement therapy: dialysis | No statistically significant difference | Very Low |
Adverse events | No statistically significant difference | Very Low |
Sodium chloride 0.9% versus sodium bicarbonate | ||
CI-AKI | No statistically significant difference | Moderate |
All-cause mortality (30 days) | No statistically significant difference | Very Low |
All-cause mortality (>30 days) | No statistically significant difference | Very Low |
In-hospital mortality | No statistically significant difference | Very Low |
Need for renal replacement therapy | No statistically significant difference | Low |
Adverse events | No statistically significant difference | Low |
Adverse events: heart failure | No statistically significant difference | Very Low |
Sodium chloride 0.9% versus oral sodium bicarbonate plus oral fluids | ||
CI-AKI | No statistically significant difference | Very Low |
Las recomendaciones que figuran en la directriz fuente For inpatients having iodine-based contrast media, consider intravenous volume expansion with either isotonic sodium bicarbonate or 0.9% sodium chloride if they are at particularly high risk; for example, if: They have an eGFR less than 30 ml/min/1.73 m2 They have had a renal transplant A large volume of contrast medium is being used (for example, higher than the standard diagnostic dose or repeat administration within 24 hours) Intra-arterial administration of contrast medium with first-pass renal exposure is being used.
Nota The guideline committee undertook both network and pairwise meta-analyses. The results in this table are for the pairwise meta-analysis. The guideline committee noted that evidence from the network meta-analysis showed that sodium chloride 0.9% and sodium bicarbonate appear to be equivalent for preventing CI-AKI. They also noted there was limited evidence on subgroup analyses and that none of those identified showed evidence of an effect from any of the interventions on the incidence of CI-AKI. The guideline committee stated that the primary outcomes for the pairwise analysis were: CI-AKI, CKD progression at 3 months following CI-AKI diagnosis, mortality up to 12 months, need for renal replacement therapy, and adverse events. Other outcomes of interest were: length of hospital stay, readmission for AKI, and health-related quality of life. See the full guideline for details of these additional outcomes.
Esta tabla de evidencias está relacionada con la/s sección/es siguiente/s:
Respuestas clínicas Cochrane
Las Respuestas Clínicas de la Cochrane (CCA) proporcionan un punto de entrada legible, sencillo y con enfoque clínico a la investigación rigurosa de las revisiones sistemáticas de la Cochrane. Están diseñadas para ser procesables e informar sobre la toma de decisiones en el punto de atención médica y se han añadido a las secciones pertinentes del texto principal de las Best Practice.
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