Understanding Renal Failure Mortality Trends and Determinants in the US (1999–2020): Impacts of the Affordable Care Act, Advancements, Disparities, and Challenges

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

In this study the authors provided a comprehensive analysis of the mortality rates of renal failure in the United States from 1999 to 2020, highlighting the need for tailored interventions and policies to address racial and ethnic disparities in renal failure mortality rates. Overall, this research provides valuable insights to guide future efforts in renal failure management, aiming to improve patient outcomes and reduce the burden of this complex condition. The manuscript is actual, representing an interesting point of reflection; the methodology is adequate and the discussion is well presented. The linguistic style should be improved in some points.

Comments on the Quality of English Language

Should be improved 

Author Response

Thank you for your thoughtful and constructive feedback on our manuscript. We appreciate your positive comments on the comprehensive nature of the study, the highlighting of the need for tailored interventions, and the acknowledgment of the research's potential impact on guiding future efforts in renal failure management.

We take your feedback regarding the linguistic style seriously and agree that there is room for improvement in certain aspects. To address this concern, we plan to undertake the following steps:

1. Linguistic Style Revision: We will carefully review the manuscript to identify specific points where the linguistic style can be enhanced. This includes refining sentence structures, ensuring clarity, and polishing the overall writing style to enhance readability.

2. Proofreading: We will conduct a thorough proofreading of the entire manuscript to rectify any grammatical errors, typos, or inconsistencies in language usage.

3. Incorporating Additional Clarity: We will work on providing additional clarity in sections where the language may be less straightforward. This involves rephrasing sentences or providing further explanations to ensure that the content is easily understandable.

4. Addressing Specific Points: If you could kindly provide specific examples or points where you believe the linguistic style could be improved, it would be immensely helpful for our revision process. We want to ensure that we address your concerns comprehensively.

We genuinely appreciate your time and effort in reviewing our manuscript and are committed to making the necessary improvements. Your feedback is invaluable to us, and we aim to submit a revised version that not only maintains the academic rigor of the study but also enhances its overall readability.

Thank you once again for your constructive feedback, and we look forward to submitting the improved manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

I read this paper with great interest. The data are interesting and well-presented. I have only a minor comment. Please provide some considerations about the costs of renal failure and if there has been an increasing in recent years.

Author Response

Thank you for your insightful feedback on our manuscript, specifically regarding the request for considerations about the costs of renal failure and whether there has been an increase in recent years. We appreciate your attention to this critical aspect of our study and understand the importance of addressing the economic implications of renal failure.

We will incorporate a dedicated section in the manuscript that delves into the costs associated with renal failure. This section will explore direct medical costs, indirect costs, and any other relevant economic considerations. By providing a comprehensive analysis, we aim to offer a more holistic view of the economic impact of renal failure.

We sincerely appreciate your guidance in focusing on the economic aspect of renal failure, and we are committed to delivering a manuscript that not only meets but exceeds your expectations. Your feedback is instrumental in refining the comprehensiveness of our study, and we look forward to providing a more robust analysis of the costs associated with renal failure.

Thank you once again for your thoughtful input.

Reviewer 3 Report

Comments and Suggestions for Authors

Salichs et al in their article entitled Understanding Renal Failure Mortality Trends and Determinants in the US (1999-2020): Impacts of the Affordable Care Act, Advancements, Disparities, and Challenges analyzed possible factors influencing mortality rates in the group of patients with renal failure . An interesting topic and issue, especially in the aspect of health effects generated by significant changes in the health care system.

The article is well written and structured.

Data presented and described clearly.

Interesting and balanced discussion.

Current and related literature related to the topic discussed in the manuscript.

Two minor comments:

  - introduction:

The sentences in lines 79-83 are unnecessary - they do not add anything important to the text.

  - discussion:

Line 274 - in this paragraph, the authors should also emphasize the role of activities aimed at obtaining a larger number of living donors, which will reduce the time for transplantation and allow patients in the pre-emptive stage to avoid renal replacement therapy.

Author Response

Thank you for your constructive feedback on our manuscript, particularly the two minor comments you provided. Your insights are invaluable, and we appreciate your thorough review. We are committed to addressing these comments to enhance the overall quality and relevance of our study.

1. Introduction - Lines 79-83: We acknowledge your suggestion regarding the sentences in lines 79-83 of the introduction. We will carefully reassess this portion of the manuscript and, where appropriate, streamline or omit the mentioned sentences to ensure a more concise and focused introduction. Our aim is to maintain clarity and relevance while eliminating any unnecessary content that does not contribute significantly to the overall narrative.

2. Discussion - Line 274: We appreciate your comment on line 274 of the discussion section, and we agree that emphasizing the role of activities aimed at obtaining a larger number of living donors is crucial. We will revise the paragraph to explicitly highlight the significance of these activities. Emphasizing their impact on reducing transplantation time and enabling pre-emptive interventions to avoid renal replacement therapy will be a key focus of our revision.

Additionally, if you have any specific suggestions or points you believe should be included in the revised paragraph, we would welcome your guidance to ensure that our emphasis aligns with your expectations.

We thank you for your thoughtful review, and we are committed to promptly implementing these revisions. Your feedback is instrumental in refining our manuscript, and we look forward to submitting an improved version that addresses your comments effectively.