PONE-D-24-37218Predicting Dietary Management Intention of Patients with Chronic Kidney Disease Using Protection Motivation TheoryPLOS ONE

Dear Dr. Huang,

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Prathap kumar Simhadri, MD

Academic Editor

PLOS ONE

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Additional Editor Comments:

Comments from the Editor-

Thank you for submitting the interesting manuscript, and our decision at this time is to " revise the manuscript". Please address all the questions raised by the reviewers and resubmit the revised manuscript.

Please clarify the parameters of the variables mentioned in the Table 1. (Weight in pounds or kilograms, Height in inches, please provide the dollar equivalent of the currency mentioned etc.)

Reviewer 1.

The manuscript is very interesting, it assesses a fundamental aspect of the treatment of patients with CKD.

In my opinion, it would be more intuitive for the reader to insert a table with the items evaluated by the questionnaire, rather than to report them in the text (line 119-128).

Reviewer 2.

I would have like to see sub analysis based on different stages of CKD as dietary restrictions are more restrictive in advanced ckd compared to CKD stage III A patients

It was done only in hospitalized patients and so there is selection bias and would be benefecial to see this hypothesis done in office patients

There were almost 88 % who were married and so unsure if results could be generalized, While the hypotheses are well-stated, presenting the results in a table specifically dedicated to hypothesis testing (e.g., whether each hypothesis is supported or rejected) would add clarity for readers.

Reviewer 3.

If the patient population had any other factors like hypertension, obesity or other cardiovascular risk factors that could make the results skewed. Otherwise the article appears to be interesting idea.

Reviewer 4.

The study is written in fluent English and well articulated. It is written with good flow in almost all the sections.

Methods used were relevant and well conducted.

Statistical analysis - did the study account for CKD stage which can inherently influence the DMI bringing in bias?

weakness remains the cross-sectional nature of the study which was also mentioned in the study limitations.

Overall the study offered valuable information for actionable items and also paved way for further longitudinal research to confirm as well as elaborate on the behavioral aspects behind dietary management intention.

Reviewer 5.

1. Very interesting and tailored approach to enhance adherence to dietary recommendations in Chronic Kidney Disease

2. Also, I have found no similar articles

3. Small word correction on page 9, line 205, 'report' instead of 'repot'

4. I am a proponent of diet modification in CKD and agree that all the current recommendations are generalized to the Western population, especially where access to processed food it very high, which plays a significant role in worsening of several chronic diseases including Diabetes, Hypertension, Heart disease and CKD, and which are more than often interconnected.

5. I feel this study lays the foundation for future large prospective or Randomized Control Trials on this topic and encourage more researchers from different continents to use similar or different approaches to study the factors influencing dietary habits of different ethnicities so that a targeted approach can be employed to reduce the global burden of CKD and ESKD.

Reviewer 6.

1) Keep the Dietary Management Intentions- consistent

Not Intention in one place and intentions in other places

2) Chronic kidney disease (CKD) is a pathological condition in which a gradual loss

of kidney function occurs over five stages classified by estimated glomerular filtration

rate . This is a clinical classification and classified into 5 stages- needs correction

3) As patients in early stages of CKD might have few signs or symptoms, they

may feel reluctant to seek and follow medical advice on managing the condition.

This statement makes more sense if it says less instead of few.

Also, this study seems more appropriate on an outpatient basis. Any explanation as to why this was intended to be done as inpatient

[Note: HTML markup is below. Please do not edit.]

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

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

**********

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

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

**********

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 is very interesting, it assesses a fundamental aspect of the treatment of patients with CKD.

In my opinion, it would be more intuitive for the reader to insert a table with the items evaluated by the questionnaire, rather than to report them in the text (line 119-128).

Reviewer #2: I would have like to see sub analysis based on different stages of CKD as dietary restrictions are more restrictive in advanced ckd compared to CKD stage III A patients

It was done only in hospitalized patients and so there is selection bias and would be benefecial to see this hypothesis done in office patients

There were almost 88 % who were married and so unsure if results could be generalizedWhile the hypotheses are well-stated, presenting the results in a table specifically dedicated to hypothesis testing (e.g., whether each hypothesis is supported or rejected) would add clarity for readers.

Reviewer #3: If the patient population had any other factors like hypertension, obesity or other cardiovascular risk factors that could make the results skewed. Otherwise the article appears to be interesting idea.

Reviewer #4: The study is written in fluent English and well articulated. It is written with good flow in almost all the sections.

Methods used were relevant and well conducted.

Statistical analysis - did the study account for CKD stage which can inherently influence the DMI bringing in bias?

weakness remains the cross-sectional nature of the study which was also mentioned in the study limitations.

Overall the study offered valuable information for actionable items and also paved way for further longitudinal research to confirm as well as elaborate on the behavioral aspects behind dietary management intention.

Reviewer #5: 1. Very interesting and tailored approach to enhance adherence to dietary recommendations in Chronic Kidney Disease

2. Also, I have found no similar articles

3. Small word correction on page 9, line 205, 'report' instead of 'repot'

4. I am a proponent of diet modification in CKD and agree that all the current recommendations are generalized to the Western population, especially where access to processed food it very high, which plays a significant role in worsening of several chronic diseases including Diabetes, Hypertension, Heart disease and CKD, and which are more than often interconnected.

5. I feel this study lays the foundation for future large prospective or Randomized Control Trials on this topic and encourage more researchers from different continents to use similar or different approaches to study the factors influencing dietary habits of different ethnicities so that a targeted approach can be employed to reduce the global burden of CKD and ESKD.

Reviewer #6: 1) Keep the Dietary Management Intentions- consistent

Not Intention in one place and intentions in other places

2) Chronic kidney disease (CKD) is a pathological condition in which a gradual loss

of kidney function occurs over five stages classified by estimated glomerular filtration

rate . This is a clinical classification and classified into 5 stages- needs correction

3) As patients in early stages of CKD might have few signs or symptoms, they

may feel reluctant to seek and follow medical advice on managing the condition.

This statement makes more sense if it says less instead of few.

Also, this study seems more appropriate on an outpatient basis. Any explanation as to why this was intended to be done as inpatient

**********

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes:  Babu Sriram Maringanti

Reviewer #5: Yes:  Vikas Vujjini

Reviewer #6: Yes:  Hari Naga Garapati

**********

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Attachments

Attachment

Submitted filename: comments for Predicting DMI of Patients with CKD Using PMT.doc

PONE-D-24-37218R1Predicting dietary management intention of patients with chronic kidney disease using protection motivation theoryPLOS ONE

Dear Dr. Huang,

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.

Thank you for revising the manuscript and it needs further minor revision before it can be accepted. Please verify the parameters of the variables mentioned in the parenthesis for the Table 1 and resubmit the revised manuscript. 

Please submit your revised manuscript by Mar 08 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Prathap kumar Simhadri, MD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Thank you for revising the manuscript and addressing all the questions raised by the reviewers. The parameters mentioned in the parenthesis for the variables Height and Weight need to be revised. Please revise the manuscript further before it could be accepted.

[Note: HTML markup is below. Please do not edit.]

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Predicting dietary management intention of patients with chronic kidney disease using protection motivation theory

PONE-D-24-37218R2

Dear Dr. Huang,

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,

Prathap kumar Simhadri, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: