Reviewer's report
Title:Health related quality of life in patients in dialysis after renal graft loss.
Effect of Gender.
Version:1Date:7 December 2013
Reviewer: Cynthia Gross
Reviewer's report:
This is an interesting paper that presents new information. The data appear
sound and in general, strengths and weaknesses of the paper are well described
by the authors. However, several problems with the analysis, interpretation and
presentation should be addressed.
Major compulsory revisions
1. The interaction analyses are not adequately described and reported. Based on
the Methods, interaction terms should have been included in the analyses shown
in Table 4, and the results reported with the other coefficients and associated p
values.
2. The plots to explain the interaction term would be more consistent with the
interpretation if gender were along the x axis and prior transplant status shown
by color.
3. List all covariates investigated but not significant in a footnote to the tables.
4. A parallel analysis for male patients to that depicted in Table 5 for females is
essential to place the Table 5 results in context.
5. In their interpretation of the significant interaction terms found, authors
consider only one mechanism, graft loss, as causal. Their cross-sectional design
cannot eliminate other explanations. Given that women report lower HRQOL than
men in the general population and in other studies of transplant and dialysis
patients, alternative explanations should be pointed out in the Discussion.
Longitudinal confirmation is needed.
6. Response shift has been associated with HRQOL perceptions after pancreas
transplantation. Address issue of response shift in QOL assessment after kidney
graft loss
7. Analysis of BMI should be based on standards for under/overweight and
obesity, not a median split, to facilitate a meaningful interpretation of findings.
Minor essential revisions
8. In the Results, for every finding, be explicit about whether the analysis was or
was not adjusted, and make the direction of the relationship clear, and for clarity,
replace “reduced “ effect of kidney disease with “poorer” or “worse”; otherwise it
sounds like greater comorbidity was associated with better HRQOL on the effect
of KD and other subscales.
9. Include the number of men and women with graft loss to the abstract.
10. Use “loss” not “failure” in the short title.
11. In the Methods, state how missing data are handled.
12. Considerable editing is needed to remove problematic word choices and fix
the grammar. A partial list includes:
a) Abstract – have not has in line 3 of abstract and reword this sentence clarify
that transitions may affect HRQOL, they will not affect the sex of the patient.
b) Drop or Reword to replace the term “gender-wise” in the Abstract and Methods
c) Page 9 – Sentence beginning “In addition to graft loss…” does not make
sense - reword.
d) Refer to the rates of “missing data” on the SF-36 and KDQOL; these are not
response rates.
e) Page 13 – replace mill with million
f) Page 14 – replace manifold (which means diverse) with many times
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.