[2018] Relative values of different outcomes The committee agreed that all-cause mortality, all-cause unplanned hospitalisation and quality of life were the most critical outcomes for determining the efficacy and potential harms of heart failure medications in people with CKD. The committee agreed that the impact of heart failure medication on renal function, and adverse events of the medication (specifically, bradycardia, arrhythmia, hypotension and hyperkalaemia) were also important outcomes. No evidence was found on the effect of any of the medications on quality of life in people with HF and CKD. Quality of the clinical evidence The evidence found was exclusively from subgroup analyses (SGA) of trials in the general HFREF population. None of the subgroups had been pre-specified and stratified, which introduced a risk of bias. Four of the SGAs were published over 10 years after the overall trial was published. The baseline population characteristics of the intervention and control arms within each subgroup were often not published, preventing a proper assessment of the risk of selection bias. The analysis was sometimes given as summary statistics only, without details regarding the numbers in each group, which may also have resulted in bias. These factors combined, along with additional bias issues specific to the individual studies and outcomes, meant that all the evidence found had a high or very high risk of bias. The studies frequently used a composite outcome of death or hospitalisation, which led to the evidence being downgraded for indirectness, as it was not possible to assess the impact on each of these critical outcomes separately. A number of medications had no reported evidence with regards to the population with CKD: loop diuretics; sacubitril-valsartan; and hydralazine- nitrate. 