PONE-D-23-38254THE PREVALENCE AND RISK OF MORTALITY ASSOCIATED WITH INTRADIALYTIC HYPERTENSION AMONG PATIENTS WITH END-STAGE KIDNEY DISEASE ON HAEMODIALYSIS: A SYSTEMATIC REVIEW AND META-ANALYSISPLOS ONE

Dear Dr. Ekrikpo,

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Ahmet Murt

Academic Editor

PLOS ONE

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Additional Editor Comments:

Our impartial reviewers recommended some major revisions for your manuscript. You can find them below.

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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: Yes

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 enjoyed reading this systematic review and meta-analysis about intradialytic hypertension in hemodialysis patients by Udeme et al. It is a well-written paper in fluent English about an underestimated clinical entity.

Strong points of the analysis are a) the inclusion of studies without geographical or language limitations b) the long study period. On the other hand the absence of a single definition of intradialytic hypertension causes confusion, when comparing prevalence rates in trials.

Minor comments

1. The different definitions of intradialytic hypertension are described in page 4, but the authors should add the A, B ,C…matches (it is stated in the supplementary file, but it is important to be clear in the main text too)

2. The fifth definition is suggested by KDIGO. This could be underlined and discussed a bit more.(less prevalence in this definition)

3. The authors should explain why they use the median values of SBP /DBP and age as cut-off values (supplementary files). I believe that it is more clinically relevant to use eg in age >65 years old vs < 65years old

4. Page 7. Ref 51 the correct form is Dorhout et al instead of Mee et al.

Reviewer #2: In this systematic review authors analyzed the incidence of intradialytic hypertension and mortality rates that is attributed to it.

As very well stated by the authors, there's no exact definition for inradialytic hypertension and this makes inclusion of different studies difficulty.

My recommendations:

1- Please give the exact dates for your included studies.

2- please clarify what are the definitions A,B,C,D and E in the text.

3- Refrain from comparing intradialytic hypertension and hypotension. This can't be the objective of this review.

4- More detailed data is necessary. Please dissect more information from the studies for risk factors that result in intradalytic hypertension and discuss widely. The discussion of this review is still poor. If there's no data in the studies for risk factors please add them as limitations.

5- Please revise the English language of your paper.

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Reviewer #1: No

Reviewer #2: No

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THE PREVALENCE AND RISK OF MORTALITY ASSOCIATED WITH INTRADIALYTIC HYPERTENSION AMONG PATIENTS WITH END-STAGE KIDNEY DISEASE ON HAEMODIALYSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

PONE-D-23-38254R1

Dear Dr. Ekrikpo,

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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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Ahmet Murt

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

In this revised version of the manuscript, our impartial reviewers are satisfied with the explanations of the authors.

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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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: With this revised version, authors have clarified all of my concerns. I have no further comments for this round of review.

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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

Reviewer #2: No

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