PONE-D-24-24065Adjusting dialysis dose (Kt) scaled to Body Surface Area (BSA) could be a more logical approachPLOS ONE 

Dear Dr. ma,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear Dr. Chunyuan Ma,

we have received the reports from our advisors on your manuscript, "Adjusting dialysis dose (Kt) scaled to Body Surface Area (BSA) could be a more logical approach", submitted to our journal Plos One.

Based on the advice received, I have decided that your manuscript could be reconsidered for publication should you be prepared to incorporate minor revisions.

When preparing your revised manuscript, you are asked to carefully consider the reviewer comments which can be found below, and submit a list of responses to the comments.

Best regards,

Dr. Diego Moriconi, MD, PhD.

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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: Yes

Reviewer #2: N/A

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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: No

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: The manuscript presents an interesting approach to scaling dialysis dose (Kt) to body surface area (BSA) instead of the conventional urea distribution volume (V) for a more accurate reflection of metabolic activity. The study is well-structured, with a clear abstract and comprehensive results.

The manuscript states that linear regression analysis was applied, but it does not provide details about the regression model assumptions, the goodness-of-fit metrics, or the potential multicollinearity issues. Including information about the model diagnostics (residual analysis, R-squared values) and any steps taken to validate the regression model would strengthen the analysis.

Reviewer #2: In this single-centre cross-sectional study, the researchers investigated the efficacy of hemodialysis, as measured by Kt/V versus Kt/BSA, in 211 patients with end-stage chronic kidney disease undergoing chronic hemodialysis. The focus of the two dialysis parameters for adequacy was on gender comparison. The inclusion and exclusion criteria are clear. The study was approved by the ethics committee and all participants signed a written informed consent. Most of the participants had an arteriovenous fistula as vascular access. The researchers found significantly higher Kt/V values in women than in men and after normalisation from Kt to BSA, the difference between the two sexes was no longer statistically significant.

The manuscript is well written, the entire text needs to be reviewed by a native English speaker.

I have the following comments, questions, suggestions:

1. When were the blood samples for the Kt/V measurements taken? At the first, second or third hemodialysis session of the week?

2. Do all patients have the same weekly schedule for dialysis sessions?

3. Data on the duration of the hemodialysis session of the participants at the time of blood sampling is missing.

4. Data on the type of dialysis (hemodialysis, hemofiltration, hemodiafiltration) are missing.

5. Minor comments:

Table 1: SBA is incorrect, it is BSA

Relationship between Kt/V and Kt/BSA by gender (not by sex)

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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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Adjusting dialysis dose (Kt) scaled to Body Surface Area (BSA) could be a more logical approach

PONE-D-24-24065R1

Dear Dr. Chunyuan Ma,

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,

Diego Moriconi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Dr. Chunyuan Ma,

we have received the report from our advisor on your manuscript, "Adjusting dialysis dose (Kt) scaled to Body Surface Area (BSA) could be a more logical approach", submitted to our journal Plos One.

Based on the advice received, the paper is considered, in light of the improvements made, suitable for publication.

Best regards,

Dr. Diego Moriconi, MD, PhD.

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 #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 #2: Yes

**********

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

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 #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 #2: Yes

**********

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 #2: The authors took into account all my suggestions and comments and I think that the paper has been improved. Thank you.

I think the article is now suitable for publication.

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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 #2: No

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