PONE-D-22-18940Referral pattern to nephrologist and prognosis in diabetic kidney disease patients: single center retrospective cohort studyPLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I’ve read with interest the draft “Association of ideal cardiovascular health metrics with incident chronic 2 kidney disease: more than a decade follow-up in the Tehran Lipid and 3 Glucose Study (TLGS)”, by Fatemeh Alizadeh, Maryam Tohidi, Mitra Hasheminia, Firoozeh Hosseini-Esfahani, Fereidoun Azizi, Farzad Hadaegh

However, some important issues have to be raised.

Introduction:

- Line 46-47. Authors should briefly introduce and define the main non-communicable diseases (NCDs).

- Line 65-66. A multifactorial treatment aimed at multiple risk factors reduces the risk of cardiovascular events in populations with type 2 diabetes mellitus and renal impairment. This issue is addressed in some recent literature which should be added to the references. Gaede P et al, N Engl J Med. 2003;348(5):383-393. doi:10.1056/NEJMoa021778; Sasso FC et al Cardiovasc Diabetol. 2021;20(1):145. Published 2021 Jul 16. doi:10.1186/s12933-021-01343-1

Methods and Materials:

- Line 128-129. Font typing error.

Discussion:

- Line 251. “china” is a typing error.

- Line 237-239. “Among middle-aged participants, the intermediate and ideal categories of BMI and BP, and the ideal category of FPG and in elderly individuals, only intermediate and ideal BP was associated with reduced risk of CKD”. The authors should better clarify the pathophysiological mechanisms/hypotheses supporting this sentence.

- Line 262. “Actually, no association was demonstrated between ICVHM and incident CKD among elder population”. It therefore seems that ICVHM does not affect the prognosis of elderly patients. However, some recent literature seems in contrast with this conclusion. The authors should better clarify the pathophysiological mechanisms/hypotheses supporting this sentence.

Reviewer #2: I read with great interest the paper “Referral pattern to nephrologist and prognosis in diabetic kidney disease patients: single center retrospective cohort study " by Iwata et al.

The article is well written. Paper design is fine. The article is logically divided into sections and subsections.

Comments:

1. Introduction: Diabetic nephropathy should be addressed to the right specialist as soon as possible to start the appropriate therapy and follow-up, in order to slow the disease progression. However, previous data have reported that despite the worst renal and cardiovascular prognosis, this subset of patients are at high risk of being under-treated independently of the type of clinical setting (nephrology, diabetology and primary care) (doi: 10.1097/01.hjh.0000239303.93872.31). This is also in contrast with the new view point of the multifactorial intervention in order to reduce the end stage kidney disease progression, but, even more importantly the cardiovascular risk factors. In fact, most of diabetic patients do not develop end stage kidney disease, as they die before (doi: 10.1186/s12933-021-01343-1).

2. Discussion, line 25-27: the authors reported that in their population the proteinuria levels are higher than in previous study, with a rapid decline in renal function. In these patients I would have also expected an increase in diabetic retinopathy onset with a consequent increase in cardiovascular events (doi: 10.1016/j.numecd.2019.05.065). Moreover, the authors reported after a line that renin angiotensin system inhibitors are used in this patients to reduce proteinuria, which is true, but with the use of this drugs we first assist to a reduction in glomerular filtration rate and after a stabilization in time, which may be compatible with a rapid decline in kidney function. Moreover, the role of SGLT2 inhibitors has been spread in this population, with an amelioration of both proteinuria and kidney function, together with a reduction of cardiovascular events, also representing the future, and not reported in the article (doi: 10.31083/j.rcm2303106).

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Reviewer #1: No

Reviewer #2: No

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Referral pattern to nephrologist and prognosis in diabetic kidney disease patients: single center retrospective cohort study

PONE-D-22-18940R1

Dear Dr. Hayashi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ferdinando Carlo Sasso, PhD, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

No further comments

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: The author managed to answer to all my queries. The paper has much improved and can be further processed for publication.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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