Dear Dr. Dadi,

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Academic Editor

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Additional Editor Comments:

Dear Dr. Dadi, 

 Your manuscript “Impaired Estimated Glomerular Filtration Rate and Associated Factors among Adult Patients Living with HIV at Asella Referral and Teaching Hospital, Ethiopia: A Cross-Sectional Study” has been assessed by two reviewers. They have raised a number of points which we believe would improve the manuscript and may allow a revised version to be published in PLOS ONE. Their reports, together with any other comments, are below.

 If you are able to fully address these points, we would encourage you to submit a revised manuscript to PLOS ONE.

Best regards,

Prof. Donovan McGrowder

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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?

Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: No

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

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: In the Introduction, the authors state that “People living with HIV (PLHIV) demonstrate diverse renal pathology, including acute kidney injury (AKI), HIV-associated nephropathy (HIVAN), chronic kidney disease (CKD), and antiretroviral therapy (ART)-induced nephrotoxicity.” Therefore, what would likely interest the readers of this paper, and what holds clinical significance, is an elucidation of the distinct characteristics associated with each underlying cause of renal impairment. This perspective, however, is lacking in the current manuscript, which I consider to be its primary limitation.

Below are some technical suggestions aimed at improving the manuscript for scientific publication:

At present, the manuscript contains a substantial number of Tables, but the data could be consolidated into a single comprehensive Table for greater clarity. For instance, in Table 6, the authors perform a univariate analysis comparing two groups: those with impaired eGFR (N=47) and those with normal eGFR (N=205). By adding a column on the left to show the Overall (N=252) data, the contents of Tables 1 through 5 could be integrated, resulting in a more streamlined presentation.

Moreover, for variables that are mutually exclusive and collectively exhaustive—such as Age >40 vs. Age <40, or Hypertension Yes/No—there is no need to list both categories in separate rows. Presenting only one category suffices and will simplify the table while maintaining clarity. This recommendation also applies to the Tables presenting multivariate analysis results.

Furthermore, the Figures in the current manuscript provide minimal informational value. For example, pie charts depicting the overall distribution of BMI or renal function are unnecessary. Figures should be used more effectively to visually aid comparisons between groups or to highlight relationships between two parameters that are not easily interpreted from Tables. Enhancing the Figures in this way would greatly improve the manuscript's readability and impact.

Reviewer #2: 1.Originality

This study offers an original contribution within the context of the region in which it was conducted—Ethiopia—where data on renal function impairment among HIV-positive patients are limited. The use of the CKD-EPI 2021 formula to estimate eGFR and the detailed analysis of associated risk factors represent both methodological and scientific strengths. This approach provides an updated perspective on a clinically relevant issue in sub-Saharan Africa.

2. Importance

HIV prevalence is high in sub-Saharan Africa, and the risk of progression to chronic kidney disease (CKD) among HIV-positive patients is significant. In this context, the study is particularly important as it highlights the need for renal screening and preventive interventions in a vulnerable population. The findings may contribute to improving care protocols and shaping locally adapted public health policies.

3. Materials and Methods

The study included 252 HIV-positive patients, whose renal function was assessed using the CKD-EPI 2021 formula. Data were collected through structured questionnaires and medical record reviews. The cross-sectional design is appropriate for estimating prevalence, and the systematic sampling of participants adds methodological robustness.

4. Results

The central finding is the prevalence of impaired eGFR (18.7%), along with the identification of significant risk factors: age over 40 years, smoking, opportunistic infections, diabetes mellitus, and hypertension. These associations support the need for targeted risk factor correction and further evaluation of HIV-positive patients to prevent progression of kidney disease.

5. Additional Questions

a.What is the average duration of antiretroviral therapy among participants, and how does it influence renal function?

b.Are there differences between the treatment regimens used?

c.Based on these results, could a follow-up evaluation algorithm be developed?

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Reviewer #1: No

Reviewer #2: No

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Impaired Estimated Glomerular Filtration Rate and Associated Factors among Adult Patients Living with HIV at Asella Referral and Teaching Hospital, Ethiopia: A Cross-Sectional Study

PONE-D-25-40706R1

Dear Dr. Dadi,

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,

Donovan Anthony McGrowder, PhD., MA., MSc

Academic Editor

PLOS One

Additional Editor Comments (optional):

Dear Dr. Dadi,

 The manuscript entitled “Impaired Estimated Glomerular Filtration Rate and Associated Factors among Adult Patients Living with HIV at Asella Referral and Teaching Hospital, Ethiopia: A Cross-Sectional” was revised in accordance with the reviewers’ comments and is provisionally accepted pending final checks for formatting and technical requirements.

Regards,

Prof. Donovan McGrowder (Academic Editor)