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PONE-D-20-21371

Sociodemographic features and mortality of individuals on haemodialysis treatment who test positive for SARS-CoV-2: a UK Renal Registry data analysis

PLOS ONE

Dear Dr. Savino,

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Muhammad Adrish

Academic Editor

PLOS ONE

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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

Reviewer #3: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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: No

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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 analysis tries to identify factors associated with mortality in a group of 1173 HD patients infected with COVID.

The objective of this study is to evaluate the survival of HD patients after 1 week and 2 weeks of positive diagnosis of SARS-COV-2.

Unadjusted survival at 1 week was 89%. (mortality was 11%)

Unadjusted survival at 2 weeks was 81% (mortality was 19%)

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The main conclusion is that the relative risk of death associated with COVID -19 in HD patients was much higher that of the general population in England.

What were the factors associated with COVID infection?

The authors analyzed only age, gender and ethnicity.

For a global analysis of mortality, in a multivariable analysis, other factors that are classically associated with higher risk of death in dialysis patients, should also have been included: time on dialysis, diabetes, albumin, CRP, phosphate levels, etc.

In my opinion, though interesting, this analysis is merely descriptive.

I had not access to the Kaplan Meyer curve.

Reviewer #2: Technically sound well written with appropriate statistical analysis. It would have been interesting to know the association of diabetes as it effected various socio-demographic groups and whether is was the main a factor for high mortality in Asian population.

Reviewer #3: Author has made an reasonable attempt to publish mortality of COVID-19 in Incentre hemodialysis patients using UKRR which has not been published before. Overall the paper reads well but I would recommend a few suggestions as below.

1. Page 3 under Introduction, 2nd paragraph please add "A recent meta-analysis reported that patients with COVID-19 developing acute kidney injury had significant 4-fold increased risk of death than patients without acute kidney injury".

Please cite paper: Survival rate in acute kidney injury superimposed COVID-19 patients: a systematic review and meta-analysis. Renal Failure. 2020 Jan 1;42(1):393-7.

2. It would be good to add in the introduction that patients with ESRD have relative immunodeficiency. I would recommend adding the following sentence to Page 3 under introduction, Paragraph 3. "ESRD patients have impairment in both innate and adaptive immunity in uremic state with decreased endocytosis, impaired maturation of monocytes and dendritic cells and malfunction of toll-like receptors contributing to relative immunodeficiency"

Please cite paper: Potential role of plasmapheresis in severe cytomegalovirus infection with ongoing immunemediated hemolysis and low complement level. Journal of Renal Injury Prevention. 2017 Sep 8;7(3):206-10.

3. Why do we think asian patients have higher mortality. I see that you have explained in the paper to a certain extent. But curious to know what age group would asians mostly fit into? Was obesity a known factor in these patients? I see that asians mostly had diabetes which by itself is a higher comorbid condition. I hope we are not biased by the fact that there is missing data on ethnicity of 22% of patients and overestimating the effect or the fact that we were unable to adjust for comorbidities?

4. Completely agree that higher age >80 mortality is very high and is a good point highlighted in the paper.

5. Would recommend adding a few lines of Conclusion after discussion part highlighting points.

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Reviewer #1: Yes: Teresa Adragão

Reviewer #2: Yes: Aasim Ahmad

Reviewer #3: Yes: Sohail Abdul Salim

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Sociodemographic features and mortality of individuals on haemodialysis treatment who test positive for SARS-CoV-2: a UK Renal Registry data analysis

PONE-D-20-21371R1

Dear Dr. Savino,

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,

Muhammad Adrish

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

You have satisfactorily answered all the queries that have been raised by the reviewers.

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

Reviewer #3: 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

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #3: 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

Reviewer #3: 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: Thank you for addressing our comments and suggestions and explaining the reasons for those that could not be addressed

Reviewer #3: Thank you for addressing the concerns and incorporating my suggestions into the paper. Paper reads well at this time.

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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: Professor Aasim Ahmad

Reviewer #3: No