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Thank you for attending to the minor revisions.
[# PeerJ Staff Note - this decision was reviewed and approved by Stefano Menini, a PeerJ Section Editor covering this Section #]
Thank you for attending to the issues raised in the previous round of reviews.
A few minor issues still require attention.
1. Please include the 95% CI for the OR given in the results subsection of the abstract.
2. Table 2 does not report correlations as stated. Please revise.
3. Revise the title of Table 3 to "Correlations between continuous variables and coronary artery calcification severity".
4. State in the Table 3 footnotes and main text the sample size for this analysis.
5. In Table 3 - do you mean age at dialysis initiation?
6. Please comment on why certain variables are associated with CAC severity but not CAC prevalence or vice versa. For example, serum phosphate is significantly correlated with CAC severity (Table 3) but not CAC prevalence (Table 4). Conversely, PTH and 25(OH)D are associated with higher odds of CAC but not severity.
Thank you for extensively revising your manuscript in line with the reviewer's suggestions. In particular, the quality of the writing has improved significantly. As you will gather from the comments below, the reviewers are mostly satisfied with your revisions, although reviewer 2 requests more insightful discussion of your findings from a mechanistic perspective.
In addition to this, I have noted major issues with the statistical analysis. Please refer to the attached annotations and attend to these matters accordingly. I would suggest that you consult with a statistician if you are unsure how to address them satisfactorily. The manuscript will not be considered further without better descriptions and justification of the analyses reported. Several other minor issues are also highlighted for you attention.
It is ok in current version
The authors made satisfactory changes which was suggested
Good and clear
The subheadings of discussion should be designed according to journal format. In its current version seems as a Review. Please remove FAR CVD and others which are not necessary
The language was revised successfully
Methodology was clarified
The presentation of findings is acceptable
In previous check I suggest to authors improve their paper with mechanism of action which clarify the possible action of FAR. Authors claimed that they improve the discussion part with discussion of a report "Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency. Blood Coagul Fibrinolysis. 2016 Sep;27(6):684-90." presented by Karahan et al. However, I can not see this part in revised manuscript (Also in reference part the mentioned article does not cited). I suggest again add a part discuss possible mechinism of action. For, instance according to my knowledge "Fibrinogen is a thrombin-coagulable glycoprotein occurring in the blood of vertebrates. This marker is getting higher amounts in thrombotic processes. By the way, albumin is an acute phase reactant and also it regulates the oncotic pressure. Lower levels may be related to increased thrombotic tendency. So, a higher FAR value can be associated with increased thromboembolic disorders". Please, create these kind of hyposthesis and discuss in the view of your findings.
The authors have addressed my suggestions. I have no more concerns.
The authors have addressed my suggestions. I have no more concerns.
The authors have addressed my suggestions. I have no more concerns.
The authors have addressed my suggestions. I have no more concerns.
All 3 reviewers' have noted significant issues with your submission and I concur with their assessment.
In particular, the manuscript requires extensive editing by a proficient English speaker and the description, justification and use of statistics need significant improvement. I would suggest that you consult with a qualified statistician before revising your manuscript as in its current state it cannot be considered for publication in this journal.
[# PeerJ Staff Note: It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful #]
[# PeerJ Staff Note: Please ensure that all review and editorial comments are addressed in a response letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate. #]
[# PeerJ Staff Note: The Academic Editor has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at [email protected] for pricing (be sure to provide your manuscript number and title) #]
The paper design should be revised according to the journal format.
The language should be redacted by a native speaker.
The patient selection criteria for tomographic scans should be clarified.
Findings are interesting and valuable. However, the methodological rules should be clarified.
Dear Authors,
I read your manuscript entitled “Association between fibrinogen/albumin ratio and severity of coronary artery calcification in patients with chronic kidney disease” meticulously. The overall idea is good and the methodology is well established. However, some points should be improved before publication as follows:
- How can you decide to make a multislice coronary computed tomography scan for a CKD patient? Is it routine for all CKD patients in your clinic? Cardiac tomography is a minimally invasive method that includes radiation and can give good results when necessary. However, it is not recommended for every patient for routine check-up purposes. There are certain standards recommended by guidelines such as AHA and ACC to decide beforehand. Please clarify your patient selection criteria.
- Did you detect any contrast-induced nephropathy in non-hemodialysis patients?
-Discussion section should be presented with a separated subheading and it should start with a descriptive sentence that indicates the novelty of your findings and a brief explanation of your main findings.
- The discussion should be improved with previous studies that focused on the relationship between coronary artery disease and FAR levels. For instance, “The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI. Am J Emerg Med. 2016 Jun;34(6):1037-42. doi: 10.1016/j.ajem.2016.03.003.”
- What are the limitations of the study? Please explain with a subheading.
- The manuscript should be revised according to journal rules described in instructions to authors
Dear Authors,
I read your manuscript with great interest. The topic is interesting. There are some major essential points that should be revised before publication:
- Do not start with a numeric to the sentence. If you want to give a number at the beginning of sentence, please use the word phrase. E.g. please phrase two hundred and eighteen rather than ‘218’.
- The language should be revised by a native speaker for immersive reading.
- The mechanism of action should be explained. The hypothesis must be based on a focus. As is known, low albumin has been associated with hyperinflammation and hypercoagulability. On the other hand, increased fibrinogen was associated with fibrinolytic and haemorheological factors. Studies conducted in this context have focused on the fact that the fibrinogen/albumin ratio may be a more effective marker in determining the clinical status in cardiovascular events*.
*Karahan O, Yavuz C, Kankilic N, Demirtas S, Tezcan O, Caliskan A, Mavitas B. Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency. Blood Coagul Fibrinolysis. 2016;27(6):684-90. doi: 10.1097/MBC.0000000000000478.
Concentrate on this point and explain your hypothesis.
- The parts of text should be designed with following subheadings: Introduction, Material and Method, Results, Discussion, Conclusion, and Limitations
no experiment
Good and qualified
Thank you for the invitation to review the manuscript. This manuscript is of interest but lacks originality and novelty in many aspects.
Abstract: This section should describe the information on the study methods i.e., study design, population, etc. The conclusion section of the abstract is quite vague requiring further modification by considering the primary objectives of the study.
Introduction: The rationale of the study is not clearly illustrated in the manuscript. Authors should discuss the availability of any other study in China and other countries estimating the association between FAR and calcification in CKD patients. If such studies exist, both in China and internationally, authors should focus on the point that why this study is needed in the presence of available data. Moreover, the discussion section should be strengthened by the implications of the study findings in the current practice and research.
Methods: the methodology of the section is quite vague and simple. Authors should follow the following headings in the method section. These headings include; ethics, study site, patients with inclusion and exclusion criteria, operational definitions, diagnostic methods, data collection along with storage and anonymity of data, and statistical analysis with defined variables along specific interferential methods used in the analysis.
Results: Authors are using the word trial throughout the manuscript. I don't think that this retrospective design could be a trial analysis. I will suggest omitting this word. Authors should describe the name of the test under each table. If the author used one-way ANOVA to differentiate between three classes of FAR, then the post-hoc analysis is missing. I will suggest having Tukey`s analysis or non-parametric analysis for the more than 2 by 2 table. Authors should also put the univariate analysis for logistic regression. It is important to describe the reason that why some specific variables were selected for logistic regression (are they selected based on the chi-square analysis or clinical plausibility, or previously reported). Which univariate p-value was served to transfer the variables into multivariate analysis? ROC curve analysis for the logistic model will make the more robust risk prediction model and will help the readers to see the accuracy of the model.
Discussion: This section lacks the considerable essence of scientific writing. Authors should focus on the comparison of their findings with the previously published data rather than describing the physiological mechanism of the factors. Authors should discuss the clinical plausibility and possible mechanism of risk factors of CAC should relate them with other studies conducted elsewhere. The authors did not adjust the confounders in all analyses and I am afraid that their findings may not be generalized in other settings. The limitation section missing, as this study is accompanied by serious limitations.
The conclusion of the manuscript is not explicit and does not provide directions to clinicians and researchers.
Important: This manuscript requires English Editing from a Native English Speaker.
This study design is poor, considering the above-mentioned comments.
Validity of the findings is markedly affected by the small sample size and impact of confounders during the analysis.
Dear Editor, This manuscript requires English Editing from a Native English Speaker.
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