PONE-D-24-41348Health-related quality of life and its predictors among chronic kidney disease patients: A hospital-based cross-sectional studyPLOS ONE

Dear Dr. karim,

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Ari Samaranayaka, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

• Abstract says logistic regression was used in the analysis. But not presented any results from that analysis. Main text says multivariate regression was done, what analyses done here is unclear, please elaborate.

• Noted the conclusions were generalized to Bangladeshi CKD population. However the recruitment of participants was from a single hospital. How representative these participants to the Bangladeshi CKD population?

• Authors presented a formula used to calculate the sample size, need to define each notation in that formula. Appears the sample size was determined to estimate a proportion with a pre-specified precision. But there is no such an estimation in analysis or results sections. Instead, analysis appeared used linear regression, it is also different to the logistic regression mentioned in the abstract. Therefore sample size estimation incompatible with the analysis done.

• Noted the number of participants was same as the estimated sample size. How did you select that number of people from all eligible patients in that hospital in that period?

• Main source of the data was questionnaires (in addition extracting from medical records). What is the mode of interviews (online?, face to face?, assisted? If so by whom?, etc). Measures taken to mitigate possible bias (eg, social desirability bias) introduced by that?

• Main outcome measure is the KDQoL score along with its dimension scores. Could you explain these scores? Eg, what is/are the possible ranges of these scores? Higher scores indicate better or worse HRQoL?

• Statistical method section says SPSS was used for statistical analysis. Then later says Stata was used for multivariable regression. Does that mean multivariable analysis is not a statistical analysis? Throughout the manuscript authors used the terms multivariate and multivariable interchangeably. These two types of analyses are very different, they haven’t done a multivariate analysis.

• Page 14. Typo. “in sufficient” instead of “insufficient”.

• Tables 4 and 5. Minus sign and “to” are both denoted by “-“ when presenting confidence intervals. This is confusing.

• What is new in this study?

• Conclusion. “Younger age was associated with lower scores in all HRQoL subscales”. Where are evidence for that statement?

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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: 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: Simple, easily understandable, appropriately narrated and explained, and conclusion matched with the objectives and purposes.

It would be informative and useful to narrate in introduction, discussion and conclusion how would this study outcome can be translated into focused tailoring of the treatment plan, bench to bedside. There should be some suggestions for future studies based on the outcome of this study.

Reviewer #2: The study examines the health-related quality of life (HRQoL) in chronic kidney disease (CKD) patients, using the Kidney Disease Quality of Life 36-item (KDQoL-36) questionnaire. The authors employed a cross-sectional design to assess HRQoL in CKD patients attending a hospital in Dhaka, Bangladesh. This design is appropriate for evaluating HRQoL at a single point in time, but as a cross-sectional study, it limits the ability to draw causal conclusions. The use of the KDQoL-36 questionnaire is well-justified, as it is a validated and widely used tool to measure HRQoL in kidney disease patients.The study provides valuable insights into the factors that predict HRQoL in CKD patients in Bangladesh, which could help inform patient care and interventions. However, methodological limitations—including the cross-sectional design, lack of detailed statistical reporting, and the potential for sampling bias—reduce the robustness of the conclusions.Recommend addressing limitations, confounders and clear explanations to further strengthen the article acceptance.

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Reviewer #1: Yes: Emran Bin Yunus

Reviewer #2: Yes: Krishna Baradhi

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Submitted filename: Recommendations.docx

Health-related quality of life and its predictors among chronic kidney disease patients: A hospital-based cross-sectional study

PONE-D-24-41348R1

Dear Dr. karim,

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,

Ari Samaranayaka, PhD

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 #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

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

Reviewer #2: I Don't Know

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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 #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

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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 #2: Overall, this study makes a valuable contribution to understanding the factors that influence HRQoL among CKD patients, particularly in a Bangladesh-based context. The findings offer important insights into how various socio-demographic, medical, and psychological factors affect patients' quality of life. However, the cross-sectional design and the limited focus on certain psychological and social aspects suggest that further research is needed to deepen our understanding and improve patient care.

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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: Yes: krishna baradhi

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