Technological Resources for Hemodialysis Patients: A Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors provided a scoping overview of technology resources that could have several benefits for patients on hemodialysis such as pill and dietary adherence, psychological effects and exercise. I think these technologies can be of use to improve the life of dialysis patients, however I am missing a few critical discussion points in this contribution, which are listed below. 

1. The title is not directly fitting, as the term 'technologies' is quite broad and can be interpreted as technologies that actually change the nature of the treatment, rather than being more auxiliary. I'd suggest using 'technology resources' in the title as well.
2. In the introduction, I am missing a brief section that explains how these technologies are not changing the nature of HD, but rather alleviating its consequences (such as depression, fatigue, and stress). It might even be beneficial to include a brief section describing technological innovations that aim to alter the fundamental nature of HD, thereby distinguishing it more clearly from the assisting/peripheral/auxiliary technologies described in this contribution. 
3. More critical, in the table and discussion it is often mentioned that quality of life is improved due to a certain technology. However, this is very difficult to put in perspective. Therefore, I would like to ask the authors to paint a complete picture of what it means for a patient to be on HD. Starting with the fact the HD is the bare minimum that needs to be done to keep a patient alive. It is not a cure, it is removing (partially) the symptoms. The five year survival rate on HD is low and HD has severe consequences on the ability to contribute to society. There are very strict dietary requirements as anything that is eaten will contribute to toxins and waste solutes in the blood that need to be dialysed out. There are >20 pills that need to be taken each day to bind certain toxins, to regulate blood pressure, etc. By stating the full impact of the treatment and disease, the improvement in quality of life can be put more into context
4. Following up on that, I would like to see a more critical discussion on whether this is a technology push or pull. Is there any patient survey that can give an insight on the wishes of patients for such technologies? Where does it rank on their priority list? I fully agree that looking into reducing depression, increasing diet and pill adherence are very important, but they are also interlinked. Patients deviate from the very strict diet to 'eat something nice' for a positive psychological effect, but this for example increases the sodium, potassium, phosphate, protein levels in their blood again. A more critical analysis of the mentioned benefits in the context of HD would make this contribution much more insightful.
5. In the introduction it is mentioned (line 63 to 65) that CKD goes beyond HD and in line 89 that the technologies can be preventive as well. It would be nice if an overview of the stages of CKD can be made and in which stages the technologies would have the most impact/use.

Comments on the Quality of English Language

Some countries in the table are not in English. For one entry Tehran is mentioned (which is a city not a country). 

Author Response

Dear Editor and Reviewers,

We are grateful for the feedback and suggestions made during our manuscript review.  The changes made have improved the quality of our manuscript, and below we provide our point-by-point response to each of the comments.

Reviewer 2 Report

Comments and Suggestions for Authors

This scoping review (ScR) focuses on digital technologies that support patients with end stage renal disease (ESRD) who are “undergoing hemodialysis” (HD, lines 100-104). The following points will help strengthen the manuscript.

1. Lines 1-3: The abstract and the introduction section of the manuscript refer to HD specifically. Please consider reflecting this in the title too.
2. Lines 22-25: Authors need to be precise and refrain from using terminology such as “including” when referring to the databases used for the ScR. Also, the names of the databases need to be precise; for example, “Cochrane”? Further, the acronyms should be written out the first time they are mentioned in each section of the manuscript. 
3. Lines 26-27: When exactly were the searches conducted? Why till 2023 (considering that we are now in August of 2025)?
4. Lines 42-104: Please revise to include if there are other reviews (systematic, scoping…) on this topic. What is the gap in the literature in terms of this topic? What was the rationale for choosing a ScR for this study?
5. Lines 42-104: Thanks for indicating that patients undergoing HD “face … daily challenges” (lines 91-95) but the focus on HD needs to be better motivated. For example, do patients with ESRD undergoing other form of therapies do not face challenges?
6. Lines 107-112: Is this “protocol” that was “ …registered on the Open Science Framework…” available?
7. Lines 107-112: Did authors publish a peer-reviewed protocol for this ScR? If yes, where?
8. Lines 114-117 & Table 1: Is it “MEDLINE” as in the abstract and in line 114 here or is it “PubMed” as in Table 1? “Psych”? “SciELO”… The databases that were part of this ScR need to be clearly identified. Please reconcile.
9. Lines 114-117 & Table 1: After the databases that were part of this ScR are identified properly, consider reporting on the search strategies in an appendix.
10. Lines 114-117 & Table 1: If the focus is on HD, why are there references to other ESRD treatments (such as the section “Kidneys Artificial” in the search strategy for Scopus) in Table 1?
11. Lines 114-117 & Table 1: Who formulated these search strategies? Who conducted these searches? What is the date of these searches?
12. Lines 141-143: Please describe fully what is meant by “technological resources” so that all of the expressions used in the “type of technology” section of Table 2 and in lines 211-221 are clear for the readership. Please revise introduction so that it aligns with this newly developed section.
13. Lines 143-144: Again, why searches were conducted “up to January 2024” considering that it is now August 2025?
14. Lines 149-156: What types of study designs were included?
15. Lines 159-165: What happened if there were more than one report from a study?
16. Lines 159-165: Who are those investigators? Please clearly identify the processes followed at each phase, identify those “2 investigators” for each phase and identify the “3rd investigator” for each phase.
17. Lines 164-165: What does “scientific articles” mean? Again, what types of study designs were included?
18. Lines 167-172: How was the data extraction form developed and pre-tested?
19. Lines 179-184 & Figure 1: Please provide an appropriate reference for “PRISMA diagram flow” (in line 181).
20. Lines 179-184 & Figure 1: Please be clear about “records identified from” list in Figure 1. As before, please reconcile with other sections. It is concerning that authors have a different list of databases in different sections of the manuscript.
21. Lines 179-184 & Figure 1: Please provide a discussion section, clearly describing what are the differences between “records”, “reports” and “studies” as reported in Figure 1 providing an appropriate references.
22. Lines 179-184 & Figure 1: Figure 1 seems to suggest that “home hemodialysis” was not part of this ScR. Please reconcile with methods section and provide a rationale.
23. Lines 185-209 & Table 2: Please consider grouping reports (or are these “studies”) that are included in Table 2 to make it easier for the readership to follow. The reports could be grouped in terms of the population they studied (such as adults and children, with clear definitions provided; for example, which group do “56 patients” in the first entry belong to). Further subgrouping into quantitative or qualitative study designs will be helpful. The typology used in Table 2 must also be clearly defined and tied back to the included study designs section of the manuscript…

Author Response

Dear Editor and Reviewer,

We are grateful for the feedback and suggestions made during our manuscript review.  The changes made have improved the quality of our manuscript, and below we provide our point-by-point response to each of the comments.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The author has done extensive journal review on digital innovation in hemodialysis patients across multiple language. 

The title of the article is too encompassing, and the text is only partly correlated.

"Technological innovations for dialysis patients:..."

It did not look into other technologies in dialysis innovation e.g. device innovation. Secondly, it only focused on HD patients and not ALL dialysis patients which would include peritoneal dialysis. 

The title needs revision to be consistent with the text or vice -versa

In line 288, mentioned reference 33: Takahashi R, Yabe H, Hibino T, Morishita S, Watanabe M, Nishioka K, Ishikawa H. The study of exercise therapy using a virtual reality system on healthy subjects assuming hospital use and intradialytic exercise. Nagoya journal of medical science 2023; 490, 85(3):490-503. https://doi.org/10.18999/nagjms.85.3.490. This article does not look into HD patient and only postulated that VR might have the same effect on HD / in high workload settings of which HD may be one of them. Would suggest omitting the reference.

Author Response

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I am happy with the response and adaptation. This contribution can be published like this. 

Author Response

Dear Revisor:

Thank you for your feedback. I’m glad the response and adaptation meet your expectations. 

Reviewer 2 Report

Comments and Suggestions for Authors

Thanks to authors for a revised manuscript.

The following points need further attention. Old numbering is used for convenience.

2. Old “Lines 22-25: Authors need to be precise and refrain from using terminology such as “including” when referring to the databases used for the ScR. Also, the names of the databases need to be precise; for example, “Cochrane”? Further, the acronyms should be written out the first time they are mentioned in each section of the manuscript.” 

Thanks for revisions. Why, for example, did authors need CDSR? What is the unit of analysis?

6. Old “Lines 107-112: Is this “protocol” that was “ …registered on the Open Science Framework…” available?” 

Thanks. Please provide the exact link in the manuscript so that it is available to the readership.

7. Old “Lines 107-112: Did authors publish a peer-reviewed protocol for this ScR? If yes, where?” Thanks for internally indicating “no”. 

Please incorporate into the manuscript with a rationale.

8. Old “Lines 114-117 & Table 1: Is it “MEDLINE” as in the abstract and in line 114 here or is it “PubMed” as in Table 1? “Psych”? “SciELO”… The databases that were part of this ScR need to be clearly identified. Please reconcile.” 

Thanks for revisions. Again, why, for example, did authors need CDSR? What is the unit of analysis? Further, why are database names in the manuscript and table in new Appendix 1 still do not match? As before, acronyms should be written out the first time they are mentioned in each section of the manuscript.

10. Old “Lines 114-117 & Table 1: If the focus is on HD, why are there references to other ESRD treatments (such as the section “Kidneys Artificial” in the search strategy for Scopus) in Table 1?”

Thanks for internal response. Please incorporate so that it is clear to the readership.

12. Old “Lines 141-143: Please describe fully what is meant by “technological resources” so that all of the expressions used in the “type of technology” section of Table 2 and in lines 211-221 are clear for the readership. Please revise introduction so that it aligns with this newly developed section.” 

Thanks for revisions. However, the “concept” is still unclear. Please add a definition of ‘technological resources’ right after the report of “the concept was technological resources” in new lines 167-168 so that the “resource type” as indicated now in new Table 1 is clear to the readership. Again, the descriptions in the introduction and “eligibility criteria” sections should be consistent with the “resource type” entries in the new table. What, for example, is a “non-immersive virtual reality” or an “exergame” or a “digital platform”…?

14. Old “Lines 149-156: What types of study designs were included?”

 Thanks. Please incorporate a clear taxonomy of study design types that were part of the “eligibility criteria”. Also, please, be clear about the definitions of these study design types. What type of a study design, for example, is a “pilot study” or a “descriptive prospective study”…?

15. Old “Lines 159-165: What happened if there were more than one report from a study?”

Thanks for internal reply. However, what does “for the synthesis we treated  them as a single study, avoiding duplication of data” mean? As a result, what did authors include in the new Table 1?

17. Old “Lines 164-165: What does “scientific articles” mean? Again, what types of study designs were included?” 

Again, please the be clear about the definitions of the study design types included in the methods section. Again, what type of a study design, for example, is a “pilot study” or a “descriptive prospective study”…?

18. Old “Lines 167-172: How was the data extraction form developed and pre-tested?”

Who are those researchers?

20. Old “Lines 179-184 & Figure 1: Please be clear about “records identified from” list in Figure 1. As before, please reconcile with other sections. It is concerning that authors have a different list of databases in different sections of the manuscript.” 

Unfortunately, Figure 1 has not been revised.

21. Old “Lines 179-184 & Figure 1: Please provide a discussion section, clearly describing what are the differences between “records”, “reports” and “studies” as reported in Figure 1 providing an appropriate references.” 

Thanks. However, it is concerning that Figure 1 still does not comply with what authors call “PRISMA 2020” guidelines. It is still unclear if authors avoided double counting in the end or not (for example, in their new Table 1).

23. Old “Lines 185-209 & Table 2: Please consider grouping reports (or are these “studies”) that are included in Table 2 to make it easier for the readership to follow. The reports could be grouped in terms of the population they studied (such as adults and children, with clear definitions provided; for example, which group do “56 patients” in the first entry belong to). Further subgrouping into quantitative or qualitative study designs will be helpful. The typology used in Table 2 must also be clearly defined and tied back to the included study designs section of the manuscript…”

Thanks for revisions. Please see above points in terms of revisions still needed.

Author Response

Dear Reviewer,

We sincerely thank you for carefully reading our manuscript and for your thoughtful comments and suggestions. We carefully revised the text, considering all feedback, which substantially improved the clarity, transparency, and rigour of our work. Below, we provide a detailed, point-by-point response to each comment. All changes are clearly indicated in the revised manuscript.

# Reviewer 1

• Old “Lines 22–25: Authors need to be precise and refrain from using terminology such as “including” when referring to the databases used for the ScR. Also, the names of the databases need to be precise; for example, “Cochrane”? Further, the acronyms should be written out the first time they are mentioned in each section of the manuscript.” Thanks for revisions. Why, for example, did authors need CDSR? What is the unit of analysis?
• Response: We appreciate the comment. The correction has been made in the manuscript.
• Old “Lines 107–112: Is this “protocol” that was “ …registered on the Open Science Framework…” available?” Thanks. Please provide the exact link in the manuscript so that it is available to the readership.
• Response: We appreciate the comment. The OSF link was corrected and is now provided.
• Old “Lines 107–112: Did authors publish a peer-reviewed protocol for this ScR? If yes, where?”
• Thanks for internally indicating “no”.
• Response: We appreciate the comment. Only the OSF registration was made.
• Old “Lines 114–117 & Table 1: Is it “MEDLINE” as in the abstract and in line 114 here or is it “PubMed” as in Table 1? “Psych”? “SciELO”… The databases that were part of this ScR need to be clearly identified. Please reconcile.
• Thanks for revisions. Again, why, for example, did authors need CDSR? What is the unit of analysis? Further, why are database names in the manuscript and table in new Appendix 1 still do not match? As before, acronyms should be written out the first time they are mentioned in each section of the manuscript.”
• Response: We appreciate the comment. The list of databases was reconciled and unified across the manuscript.
• Old “Lines 114–117 & Table 1: If the focus is on HD, why are there references to other ESRD treatments (such as the section “Kidneys Artificial” in the search strategy for Scopus) in Table 1?”
• Response: We appreciate the comment. This was clarified as a MeSH/DeCS descriptor to increase sensitivity.
• Old “Lines 141–143: Please describe fully what is meant by “technological resources”…
• Thanks for revisions. However, the “concept” is still unclear. Please add a definition…
• Response: We appreciate the comment. The definition of “technological resources” was added and aligned across the manuscript.
• Old “Lines 149–156: What types of study designs were included?”
• Response: We appreciate the comment. The eligible study designs were specified in the manuscript.
• Old “Lines 159–165: What happened if there were more than one report from a study?
• Thanks for internal reply. However, what does “for the synthesis we treated them as a single study, avoiding duplication of data” mean? As a result, what did authors include in the new Table 1?
• Response: We appreciate the comment. We clarified in the manuscript that no duplicate reports were found; each entry in Table 1 corresponds to a unique study.
• Old “Lines 164–165: What does “scientific articles” mean? Again, what types of study designs were included?”
• Response: We appreciate the comment. The expression was removed and the study designs clarified.
• Old “Lines 167–172: How was the data extraction form developed and pre-tested? Who are those researchers?”
• Response: We appreciate the comment. The process of development, pre-testing, and researchers involved was described in the manuscript.
• Old “Lines 179–184 & Figure 1: Please be clear about “records identified from” list in Figure 1… Figure 1 has not been revised.
• Response: We appreciate the comment. Figure 1 was revised to match the Methods section.
• Old “Lines 185–209 & Table 2: Please consider grouping reports…
• Thanks for revisions. Please see above points in terms of revisions still needed.
• Response: We appreciate the comment. Table 2 was reorganized by population and study design, consistent with eligibility criteria.

Thanks for the revisions. Please see the above points in terms of revisions still needed.
We are deeply grateful for the reviewers’ and editors’ constructive feedback. The revisions made in response to the comments substantially improved the transparency, consistency, and clarity of our manuscript. We hope the revised version meets the journal’s high standards.