All reviews of published articles are made public. This includes manuscript files, peer review comments, author rebuttals and revised materials. Note: This was optional for articles submitted before 13 February 2023.
Peer reviewers are encouraged (but not required) to provide their names to the authors when submitting their peer review. If they agree to provide their name, then their personal profile page will reflect a public acknowledgment that they performed a review (even if the article is rejected). If the article is accepted, then reviewers who provided their name will be associated with the article itself.
Congratulations.
Yours,
Yoshi
Prof. Yoshinori Marunaka. M.D., Ph.D.
Thank you for inviting me to review this manuscript again. The authors have successfully addressed my previous comments. I have no further questions.
Thank you for inviting me to review this manuscript again. The authors have successfully addressed my previous comments. I have no further questions.
Thank you for inviting me to review this manuscript again. The authors have successfully addressed my previous comments. I have no further questions.
Please revise the manuscript according to the final minor comment by the reviewer and resubmit the revised one.
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
No comment.
No comment.
In Figure 4C, the ORs for dialysis from the 5 studies are extremely wide, with upper bounds of CIs as 176.69, 1692.51, 211.90, 26.99, and 30.98 (Ishikawa et al. 2014; Kim et al. 2021; Lu et al.
228 2023; Sang et al. 2021; Toyoda et al. 2023). Please explain this. Are there major flaws in the selected publications?
As noted by Reviewer 2, the authors did not adequately address how they pooled HR, RR, and OR together, and the sources of heterogeneity have not been thoroughly explored or analyzed. The authors have merely changed the description from RR to OR without altering the result numbers.
The issue of pooling event ratios and time-to-event results remains unresolved.
Moreover, the detailed statistical methods (e.g., DL method or Hartung-Knapp-Sidik-Jonkman method for calculating the 95% CI) were not provided.
Finally, the authors also removed several databases from the systematic review, yet the main results remained unchanged.
Therefore, you must address these comments and justify why this appears to be the case
Yours,
Prof. Yoshinori Marunaka, M.D., Ph.D.
No comment.
The research question is well-defined. I have no comment.
The authors have addressed my comments regarding the validity of the findings. The authors have updated the manuscript to account for the differences between the from odds ratios (OR), relative risks (RR), and hazard ratios (HR). However, even though you done research and tried to combine the three estimates using the conversion formulas, it is still not recommended. I would recommend to also report the values separately and combined without conversion formulasa as sensitivity analysis. And mentioning this as a limitation of this study is also recommended.
Comment 1: The issue related to the combination of hazard ratios (HR) and odds ratios (OR) has not been fully addressed. The reference 18 discusses the combination of OR and relative risk (RR), but not HR.
Comment 2: In Figure 4, the author concluded that dialysis is a risk factor for AKI. This is a strange result, as the need for dialysis is one presentation of severe AKI.
Comment 3: Heterogeneity remains a major issue in this study. For the AKI risk analysis, some risk factors exhibited substantial heterogeneity, but the author has not adequately analyzed this problem.
Comment 4: Detailed methods for pooling the effects, calculating between-study variances, and calculating the 95% confidence intervals should all be provided.
Comment 5: The choice of OR was not based on the heterogeneity test, but the author stated, "Based on the heterogeneity test (Q test) and I² statistic, corresponding models were used to calculate the pooled OR value." This approach needs clarification.
n/a
n/a
n/a
All the clarifications given are satisfactory.
Adequate and appropriate.
Satisfactory and in commensuration with the objectives of the study.
None
Dear Dr. Li,
If you feel you can revise your manuscript according to the reviewers' comments, please revise your manuscript and submit it. Please also send us your written responses to each of the reviewers' comments.
Yours,
Yoshi
Prof. Yoshinori Marunaka, M.D., Ph.D.
The manuscript addresses an important research topic concerning the incidence and risk factors for acute kidney injury (AKI) following lung transplantation. It employs a conventional structure that effectively outlines the study's objectives, methodology, findings, and conclusions, which aids in understanding the complex data presented. Nevertheless, there are several areas where the manuscript could be improved:
Line 43-44: The background is clear, but it lacks recent statistics or studies to underline the relevance of the research topic. Please include specific data or trends that could strengthen the rationale for the study.
Line 51: It should be “Acute” instead of “acute”.
Line 65-66: Please clarify why the risk factors for the incidence of AKI after LT remain controversial.
Table 2: Please clarify what “*” means in this table.
Table 3: Please report all p values into three digits.
Table 4: Please spell out ES.
The research question is well-defined. However, one major issue is regarding the ethics approval document. Please check if you have uploaded the correct file for “approval documentation” in supplementary material. Also please address the comment below:
Line 81-85: Looks like you have included studies with language are not in English. Please indicate which studies are not in English in the results.
Please address the comments below regarding the validity of findings:
Line 87: Please clarify the rationale for exclusively including case-control studies in the systematic review.
Line 114-115: Combining results from odds ratios (OR), relative risks (RR), and hazard ratios (HR) in a single meta-analysis is not generally recommended because each measures a different aspect of the relationship between exposure and outcome. Please consider only combining study results with the same effect size measures. Please report which study have reported OR, RR, or HR. Also, looks like you have described them as OR in this study instead of RR.
Line 119-120: Please clarify why you are doing a sensitivity analysis of the literature involving smokers but not the other factors.
Li et al presented an overall well-structured meta-analysis study to investigate the Incidence and risk factors for acute kidney injury after lung transplantation.
The source databases seem to include several non-English databases. Does that mean that the author did not restricting English-only studies in this meta-analysis? If yes, it's suggested to further add additional description in the study design section, e.g., the inclusion/exclusion criteria.
The findings of this study were well-presented and consistent with prior literature results.
Comment 1: There are only two authors? If there is disagreement about the enrollment criteria or risk of bias assessment, how is it resolved? The author mentions a third author not listed in the author list (disagreements were resolved through discussion or consultation with the third investigator, Xinran Yang).
Comment 2: Sinomed, Wanfang, and VIP are not familiar or commonly used online resources for systematic reviews. The authors might consider removing them or, at the very least, providing a brief introduction.
Comment 3: For an occurrence rate or incidence rate study, why do the authors only include case-control studies?
Comment 4: I do not think combining HR with RR or OR is an accurate method (OR, RR, or HR for the risk values of each study, which were described as RR in our study).
Comment 5: I suggest the authors discuss some other risk factors in critical illnesses, and if possible, include these factors in the analysis, such as exposure to PPI, anemia, and hypoalbuminemia. I also suggest citing some articles that discuss the risk factors for AKI.
ref 1:Use of the Renal Angina Index in Determining Acute Kidney Injury. Kidney Int Rep. 2018 Feb 3;3(3):677-683. doi: 10.1016/j.ekir.2018.01.013
ref 2:Risk factors and prognosis assessment for acute kidney injury: The 2020 consensus of the Taiwan AKI Task Force. J Formos Med Assoc. 2021 Jul;120(7):1424-1433.
ref 3: Acute kidney injury risk assessment at the hospital front door: what is the best measure of risk? Clin Kidney J. 2015 Dec;8(6):673-80.
Comment 6: Incidence should be presented as event, per patient per year at risk. Occurrence rate might be more accurate
Comment 7: The choice of random effect model should not based on heterogeneity analysis. Thought in this study, the use of random effect model is appropriate, authors should change the description
"According to the results of the 153 heterogeneity test (I2 = 90.4%, P = 0.001), a random effects model was selected for analysis"
Comment 8: Did author consider to use forest plot to present the result
Comment 9: For high heterogeneity regarding occurrence rate, did author consider to conduct additional subgroup analysis to explore the source of heterogeneity, or meta-regression
as above mentioned
as above mentioned
The article "Incidence and Risk Factors for Acute Kidney Injury After Lung Transplantation: A Systematic Review and Meta-Analysis" by Nuan Li and Haoxing Ying investigates the incidence and risk factors associated with acute kidney injury (AKI) post-lung transplantation (LT). The study systematically reviewed 19 case-control studies involving 1,755 AKI cases and 1,404 non-AKI cases. Using Stata15.0 for data analysis, the authors identified several risk factors for AKI post-LT, including pulmonary fibrosis, hypertension, pre-operative mechanical ventilation and extracorporeal membrane oxygenation (ECMO), double lung transplantation, cardiopulmonary bypass support, cardiovascular events, intraoperative hypotension, postoperative ECMO, sepsis, and dialysis.
The article provides a thorough review of existing literature, consolidating data from 19 case-control studies. This enhances the reliability of the findings. The findings are clinically significant, providing actionable insights for healthcare professionals to improve early detection, diagnosis, and treatment of AKI post-LT. However, its not written well. Discussion part of he manuscript initially looks like a mini introduction followed by a. mini review of literature which is not the ideal way of writing. Few paragraphs were given over rating compared to others such as those related to ECMO. The risk factors may be discussed paragraph wise without adding theoretical aspects and descriptions. Dialysis is not a risk factor for AKI and is the therapy of AKI. Rather, “dialysis requiring AKI “may a be a risk factor for mortality which can be evaluated.
The included studies exhibit significant heterogeneity, which could affect the reliability of the pooled results. This is indicated by the high I2 statistic (>50%) for some analyses. The Egger’s test results suggest the presence of publication bias for some variables, particularly sepsis, which might skew the overall findings. Most studies are case-control in nature and may not be representative of all LT patients, limiting the generalizability of the findings. The diagnostic criteria for AKI vary across the included studies (KDIGO, AKIN, RIFLE), which might introduce inconsistencies in the reported incidence and risk factors. The study does not adequately address the severity of AKI, which could have provided more nuanced insights into the risk factors and outcomes associated with different grades of AKI.
Suggested Corrections
1. Please rewrite discussion part completely with proper analysis of the data.
2. Utilize subgroup analyses or meta-regression to explore sources of heterogeneity and provide more homogeneous subgroup results.
3. Include a funnel plot to visually assess publication bias and consider using statistical methods to adjust for it.
4. Clearly define and standardize the diagnostic criteria for AKI across all included studies to ensure consistency.
5. Include a detailed analysis of the severity of AKI (using standardized grading systems like KDIGO stages) to provide more comprehensive insights into the risk factors and outcomes.
Appropriate
Adequate
Highlighted already in the above writeup.
All text and materials provided via this peer-review history page are made available under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.