Evidence

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

OutcomeEffectiveness (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

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