PONE-D-24-38687Selection of timing of continuous renal replacement therapy in patients with acute kidney injury: a meta-analysis of randomized controlled trialsPLOS ONE

Dear Dr. Xia,

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Wangari Waweru-Siika, FRCA

Academic Editor

PLOS ONE

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A numbered table of all studies identified in the literature search, including those that were excluded from the analyses. 

For every excluded study, the table should list the reason(s) for exclusion. 

If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed.

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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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: Thank you for this interesting submission and for the opportunity to review.

Briefly, the authors undertook a systematic review and meta-analysis of early vs. delayed CRRT for patients with acute kidney injury. They included 12 trials and pooled outcomes suggest that early CRRT did not confer a mortality advantage while at the same increasing adverse events.

I have a number of major and minor comments for the authors to consider.

Major:

1. My biggest comment relates to the rationale or justification for undertaking this review given the rich data available in previous and relatively recent high-quality reviews (see: https://pubmed.ncbi.nlm.nih.gov/33407756/ https://pubmed.ncbi.nlm.nih.gov/33407756/ and https://pubmed.ncbi.nlm.nih.gov/32334654/ as examples). If the rationale is that these reviews were not exclusively restricted to CRRT, it still begs the question as to why we think a special comparison of early vs. late CRRT is relevant to the reader. We know from prior studies and meta-analyses that the mode of dialysis in AKI has not shown to influence outcomes (for example: https://www.sciencedirect.com/science/article/abs/pii/S0883944117301727) nor has the timing. Also, the Cochrane review includes a sub-analysis by mode. I am thus hard-pressed to understand what new information the current review is contributing.

The authors need to substantiate and provide a convincing rationale for undertaking this exercise.

2. Was the protocol registered on PROSPERO or an equivalent publicly available repository to evaluate the adherence to prespecified aims and analysis plans?

3. The authors mention they conducted the review in accordance with PRISMA guidelines (methods, lines 48 and 49): PRISMA is a guideline for reporting systematic reviews and not for the conduct. Please correct this.

Minor:

1. How were disagreements resolved? (search strategy, lines 55 and 56)

2. Exclusion criteria: what do they mean by 'repeated analysis of experimental data'? (lines 63 and 64)

3. Table 1: There seem to be issues with referencing and it shows up in the document as 'errors'. Please fix this.

4. Attention needs to be paid to consistency of decimal points throughout the manuscript. Authors should stick to 1 or 2 decimal places and be consistent.

5. Lines 111: change 'main ending' to 'main outcome' or 'primary outcome'

6. Line 113: change 'composite mortality' to 'pooled mortality'

7. Authors refer to 14-day, 60-day and 90-day mortality outcomes as rates. These are not really rates and are instead percentages or proportions. Please correct this.

8. Table 2 is best presented as a forest plot. Also what is the rationale for the break up of the age subgroup as less than 64 and more than 64 years? And how was the cut off for SOFA and APACHE defined as low and high?

9. in the PRISMA flow diagram, under 'screening' the authors report that they excluded 2443 studies- why? Please list the reasons.

Reviewer #2: The threshold value of I2 should not be used to determine random or fix models. The two methods have different assumptions and research aims. Need to evaluate more carefully the nature of studies and check whether they share a common effect.

Table 1. Study column: Error. Reference source not found.

Figure 1 provide reasons for excluding 2443 records.

Forest plot figures, Change the left column title as “Study” instead of “Study or Subgroup”.

Capitalize the first letters of some studies.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-24-38687R1

Selection of timing of continuous renal replacement therapy in patients with acute kidney injury: A meta-analysis of randomized controlled trials

PLOS ONE

Dear Dr. Xia,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we have decided that your manuscript does not meet our criteria for publication and must therefore be rejected.

I am sorry that we cannot be more positive on this occasion, but hope that you appreciate the reasons for this decision.

Kind regards,

Wangari Waweru-Siika, FRCA

Academic Editor

PLOS ONE

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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: (No Response)

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: Partly

Reviewer #2: (No Response)

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

Reviewer #1: Yes

Reviewer #2: (No Response)

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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: (No Response)

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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: (No Response)

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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: Unfortunately, my major concern related to the rationale of undertaking this exercise remains unanswered.

Also, I do not see a point by point response letter to the comments.

Reviewer #2: All my concerns were addressed.

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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

**********

[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.]

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For journal use only: PONEDEC3

Selection of timing of continuous renal replacement therapy in patients with acute kidney injury: A meta-analysis of randomized controlled trials

PONE-D-24-38687R2

Dear Dr. Xia,

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,

Fabio Sallustio, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: