Treatment of Gout in Patients with CrCl ≤30 mL/min and/or on Hemodialysis: A Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

#1 A number of syntax errors are present and need to be corrected. 
#2 reference 29 needs a journal entry.

#3 Might mentioned SGLT medication’s and their affect on lowering uric acid especially in patients with comorbidities. 

Comments on the Quality of English Language

Moderate number of syntax errors which need to be corrected. Examples appear in line 108, 151 which should be milligrams percent, 208 262 in which I am not sure what he means by separated by kidney function. Reference 29 does not have a journal mentioned and line 278.

Author Response

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.    

I will correct the syntax errors. I added the journal in reference 29. To mention SGLT medication’s, the article will become longer, though other reviewers have said that the article is too long and needs to be shortened. 

Reviewer 2 Report

Comments and Suggestions for Authors

Comments and Suggestions for Authors

The authors provide a review focused on examining the evidence for various pharmacologic and non-pharmacologic 20 approaches to managing gout in CKD.

Although this research is not novel, it may require revisions.

Title and Abstract

- Is well formulated.

- The abstract respects the recommendations and contains the essence.

Introduction

- The information related to the gout disease, treatments, and the impact of those on the CKD, are well described and documented.

The main content:

-             Structurally and clear explosion of every treatment recommended by the ACR, EULAR.

-             The tales contain the essence and are well structured to be very easy to read and understand.

-             The review synthesises current evidence while underscoring knowledge gaps, providing a framework to advance clinical care and research on gout in CKD.

A welcome review for both rheumatologists and nephrologists. The importance and key role played by the kidneys in this rheumatic pathology and not only that, is vital.

Author Response

Thank you very much for taking the time to review this manuscript.  I updated the reference list and fixed what was missing. 

Reviewer 3 Report

Comments and Suggestions for Authors

-row 143: with will, to be changed with which will

-row 148: induce and epithelial, to be changed with induce an epithelial

-rows 151-153: review phrasing; I do not understand what you are saying

-no need to explain CKD abbreviation every time it is used (like in rows 230, 265, 273, 352)

-usage of multiple terms for the same condition, each with different abbreviations: end stage renal disease (ESRD) and end stage kidney disease (ESKD)

-references 25, 35, 36, 43 are the same

Comments on the Quality of English Language

review phrasing

Author Response

Thank you for your careful review of my manuscript and thoughtful feedback. I have made the following changes per your suggestions:

1. In row 143, I have changed "with will" to "which will".

2. In row 148, I have corrected the phrase to "induce an epithelial".

3. For rows 151-153, I apologize that my phrasing was unclear. I have reviewed this section and made edits to improve clarity and precision.

4. Per your suggestion, after the initial definition, I have removed explanations of the CKD abbreviation on subsequent uses throughout the manuscript (such as in rows 230, 265, 273, 352).

5. Thank you for noting the inconsistent terminology and abbreviations for end stage renal/kidney disease. I have standardized the phrasing to "end stage renal disease (ESRD)" throughout.

6. There were indeed duplicate references. I have removed duplicate references 25, 35, 36, and 43.

Reviewer 4 Report

Comments and Suggestions for Authors

Dear authors, although hyperuricemia and renal insufficiency often and coincidentally influence each other unfavorably and thus result in a high social and individual disease burden, there are few studies on optimal management.

In this review, pathogenesis and interactions are addressed and potential therapeutic agents and their dosage in renal insufficiency are presented. This summary is a clinically important tool.

Unfortunately, the text is a bit long and there are many almost identical repetitions of words, e.g. these from the introduction are then repeated again in the later chapters. The discussion is also unnecessary since the aspects have already been discussed in the previous chapters.

Significantly shortening the propedeutic text increases the chance that the reader will not stop before reaching the essentials.

In the methodology you did not clearly state whether there were language limitations in the search (e.g. only English).

In Chapter 3 you mention "Role of renal impairment in urate metabolism", but mainly describe the influence of hyperuricemia on kidney function.

Line 147 should contain which instead of with

The sentence in lines 149-151 is out of context (general statement behind specific explanation)

The claim lines 157-159 is illogical. If the kidney excretes less uric acid and the serum level increases, the urine level should decrease and not increase.

Table 1 lists doses for corticosteroids but not for which ones (hydrocortisone? prednisolone? dexamethasone?)

For IL-1 antagonists, a dose of 100 mg every other day is recommended but anakinra is not explicitly mentioned. This needs to be supplemented because canakinumab is dosed differently. The possible restrictions on approval and the costs should also be pointed out here.

Author Response

Thank you for your thoughtful feedback on our manuscript. We appreciate you taking the time to provide such detailed and constructive comments. Please find our responses below:

1. We agree that there is some repetition between the introduction and later sections that can be condensed. We have gone through the manuscript to streamline and reduce redundancy.

2. Per your suggestion, we have shortened the background sections to more directly highlight the key gaps this review aims to address. This will better engage readers on the essential content.

3. Regarding methodology, you are correct that we should have explicitly stated any language limitations. The search was conducted in English only. This has been clarified.

4. We have retitled section 3 to accurately reflect the content on the influence of hyperuricemia on kidney function. Thank you for catching this inconsistency.

5. In line 147, "with" has been changed to "which" as suggested.

6. We have made the statement of lines 149-151 more clear. 

7. You raise an excellent point regarding the illogical statement in lines 157-159. We have revised this section to accurately present the changes that would be expected in urine uric acid levels.

8. In Table 1, we have now specified the corticosteroid agent which is prednisone.

9. For IL-1 antagonists, the 100mg dose has been explicitly linked to anakinra. 

Round 2

Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for the repetition and the corrections.

The article is still extended and some redundant parts have not been cleared.