Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
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.
Population: Adults who are at risk of CI-AKI
Intervention: Sodium chloride 0.9%
Comparison: No intravenous hydration, oral fluids, sodium chloride 0.45%, sodium bicarbonate, oral sodium bicarbonate plus oral fluids
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (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 |
Recommendations as stated in the source guideline 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.
Note 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.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- Do statins help prevent acute kidney injury after surgical procedures requiring cardiac bypass?
- What are the benefits and harms of ischemic preconditioning for reducing renal ischemia reperfusion injury?
Use of this content is subject to our disclaimer