PONE-D-24-17737Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patientsPLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

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

Reviewer #1: Yes

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Reviewer #1: 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

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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: This study investigates the relationships between subject and object cognitive complaints and functional interference and treatment nonadherence, emphasizing the importance of subjective cognitive evaluation in practical settings. The study addressed an important issue in hemodialysis patients with reliable results, The expression in the article is good and the content is relatively comprehensive.

As an important disease that is related to all-cause death and other adverse outcomes, cognitive impairment in HD patients has already been a research hotspot in clinical settings. The following are only some suggestions to the authors:

First, the authors applied the SEM model to demonstrate that subjective cognitive complaints and everyday problem-solving skills appear to be stronger predictors of functional outcomes compared to objective performance. However, as a cross-sectional study, it's hard to determine the cause-and-effect relationship between two or more variables, a kind of association in the results couldn’t easily be explained with one variable being the cause and the other one being the outcome. It is also not proper to regard functional interference and treatment nonadherence as a certain kind of outcome, which is also commonly used in a cohort study, so the expressions in the manuscript should be adjusted to avoid misunderstanding.

Also, the results of this study showed that subjective cognitive complaints were related to functional interference and treatment nonadherence, does that mean objective assessment of cognitive impairment is not necessary before the patients have complaints? Generally, we could have a valuable time window between objective and subjective cognitive impairment, which may provide effective interference to the patients.

Second, the MoCA used in this study is only a screening tool for mild cognitive impairments, the author should explain why they didn’t apply the standard diagnosis tests for cognitive impairments.

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Reviewer #1: Yes: Yang Luo

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Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients

PONE-D-24-17737R1

Dear Dr. Griva, 

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,

Henry H.L. Wu, MBChB PGCert

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have satisfied the comments from the initial review

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

**********

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 more comments to the authors. I think the authors have made enough change about the limitaion that they have after the revision. I recommend this paper to be published in your journal.

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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: Yes: Yang Luo

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