PONE-D-24-07202Anticoagulation-related complications and their outcomes in hemodialysis patients with acute kidney injury at selected hospitals in Ethiopia.PLOS ONE

Dear Dr. Kedir,

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Additional Editor Comments (if provided):

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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: Yes

Reviewer #2: Yes

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

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Reviewer #1: Yes

Reviewer #2: Yes

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

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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 read with interest the paper by Kedir et al. about bleeding and clotting complications in HD patients treated for AKI. The paper has some limitations, mainly due to the challenging and different settings than usually observed in Western countries; I only suggest some revisions to improve the comprehension and generalizability of study results.

- The anticoagulation strategies greatly vary between centers; please indicate how many patients do not receive heparin, the reason, and the outcomes in this subgroup. At the same time, the authors can state the reason for the unavailability of citrate anticoagulation (difficulty in supplying? Costs? Both?) considering the advantages in AKI patients (see as example 10.3390/biomedicines11092570)

- The correlation between blood flow rate and clots may be direct (e.g., hemodynamic problems in the patients with low tolerance to the treatment) or indirect (e.g., problems in the vascular access limiting the flow rate favoring clot formation). Please specify the primary cause of reduced blood flow in patients with clotting and comment on it.

- If I understand correctly, all patients have central venous catheters as vascular access. Please include the characteristics of the CVC (materials, tunneled or not, temporary or permanent) and the site (jugular/femoral vein) because all these characteristics may influence the clotting risk. If possible, mention the machinery and technique adopted for the dialysis sessions (HD, HDF, hemofiltration).

Reviewer #2: The manuscript by Kedir et al. “Anticoagulation-related complications and their outcomes in hemodialysis patients with acute kidney injury at selected hospitals in Ethiopia” looks interesting. This article aims to evaluate anticoagulation outcomes and related factors in hemodialysis (HD) patients with acute kidney injury (AKI) at selected hospitals in Ethiopia. Descriptive statistics were utilized to summarize the data from AKI patients undergoing HD during October 2021 to March 2022, and multinomial logistic regression analysis was employed to identify factors associated to clotting and bleeding. The authors found that clotting affected 19.4% of participants, while bleeding occurred in 15.4%, underscoring the importance of close monitoring.

The manuscript is well written and provides enough strategies to fulfill its aims, though language may need some polishing for better flow. In conclusion, I support publication of this work and believe that it would be interesting for researchers working in the field.

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Reviewer #1: No

Reviewer #2: No

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Anticoagulation-related complications and their outcomes in hemodialysis patients with acute kidney injury at selected hospitals in Ethiopia.

PONE-D-24-07202R1

Dear Dr. Kedir,

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,

Peter R. Corridon

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

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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

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

Reviewer #1: 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

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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

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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: The Authors have revised the manuscript according to all suggested comments. All primary issues have been addressed, especially considering the specific geographical area and related problems. In my opinion, no further comments are requested.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

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

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