PONE-D-24-07951Long-term survival of patients receiving home hemodialysis with self-punctured arteriovenous accessPLOS ONE

Dear Dr. Okada,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

As pointed out by both reviewers, the findings of this study are very useful to the nephrology  community and the long-term follow-up of patients is favorable which encourages the use of home hemodialysis, a technique that is still underused globally. I kindly ask the authors to address the minor comments of reviewers, mainly reviewer#1, before the paper is accepted.

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Kind regards,

Mabel Aoun, MD, MPH

Academic Editor

PLOS ONE

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Thanks to the authors for their efforts. I have a few points to address regarding this study:

1. The lack of a control group to compare the results with. For example, a control group could consist of in-center hemodialysis patients from the same dialysis facility, matched for age and comorbidities, over a relevant follow-up period.

2. The study included home hemodialysis patients as one group, regardless of their previous kidney replacement therapy. This could potentially affect the results, as patients with prior kidney replacement therapies, especially in-center hemodialysis, or kidney transplantation, may have been exposed to additional factors compared to patients who started home hemodialysis directly.

3. Although patient education before starting home hemodialysis is considered an important issue, there is no mention of the education practices in the dialysis facility. How long was the education provided? What were the means of education?

Reviewer #2: In this retrospective study, the authors describe a very favorable technical survival (defined as death or treatment failure) in their cohort of patients.

Although this was a monocentric study with a relatively small cohort, it was followed over the long term for 19 years, one of the longest reported in the literature. The cohort is well described, attrition bias is low, and the statistical tests used seemed relevant and correctly conducted.

As the authors point out, the transposability of the results may be limited, as the hemodialysis regimen varies with the country and health system. The system used is specific to their center using high dialysate flow hemodialysis rather than low flow. Another special feature is using not only frequent HD, but also relatively long session times.As the authors point out too, the center effect is important in home hemodialysis, and results depend on the center's experience, the type of patients treated and the resources deployed.

However, the very favourable long-term experience with a low drop-out rate is interesting to consider, and the risk factors of age and diabetes on the one hand, and the quality of the vascular approach on the other, are well characterized.

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Reviewer #1: No

Reviewer #2: No

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Long-term survival of patients receiving home hemodialysis with self-punctured arteriovenous access

PONE-D-24-07951R1

Dear Dr. Okada,

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.

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Kind regards,

Mabel Aoun, MD, MPH

Academic Editor

PLOS ONE

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