AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2641-0419/439
1Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Korea
3Department of Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
4Division of Vascular and Transplant Surgery, Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Gyeonggi-do, Korea
5Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
*Corresponding Author: Jeong-Kye Hwan, Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Citation: Jeong K. Hwang, Hyung J.Cho, Ju H. Yoo, Mi H. Kim, Kyung J. Ko, Kang W. Jun, et al, (2025), Association between End-Stage Renal Disease and Abdominal Aortic Aneurysm: A Nationwide Population-Based Cohort Study, J Clinical Cardiology and Cardiovascular Interventions, 8(1); DOI: 10.31579/2641-0419/439
Copyright: © 2025, Jeong-Kye Hwan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 01 January 2025 | Accepted: 15 January 2025 | Published: 29 January 2025
Keywords: aortic aneurysm; abdominal; end-stage kidney disease; association
Background
Abdominal aortic aneurysm (AAA) and end-stage renal disease (ESRD), defined by need for chronic renal replacement therapy, have similar epidemiological profiles and pathogenic mechanisms. However, studies testing for a connection between these two illnesses are rare. In this research, we tested the hypothesis that there is an association between AAA and ESRD.
Materials and Methods
Data from 2009 to 2015 were extracted from the Korean National Health Insurance Service database for this investigation. The study encompassed 16,671 individuals who had received a new AAA diagnosis. To form a control group, 50,013 participants without the diseases were selected using propensity score matching based on age and sex. The primary endpoint of this study was newly diagnosed ESRD.
Results
The hazard ratio (HR) of ESRD incidence in the AAA group was 2.5 (95% CI 2.0-3.2); in addition, when the AAA group was divided into surgical and non-surgical groups, the HR of the non-surgical group was 2.0 (95% CI 1.5-2.6). When AAA, chronic kidney disease (CKD), and proteinuria co-occurred, the HR of ESRD incidence increased to 128.7 compared to the cases without AAA. There were interactions of diabetes mellitus (DM), CKD, and proteinuria with incidence of ESRD (p < 0.05). In the absence of these comorbidities, the HR for ESRD was higher in the presence of AAA [1.6 vs. 3.8 (DM), 2.3 vs. 3.4 (CKD), and 1.8 vs. 3.0 (proteinuria)].
Conclusions
Our findings revealed a significant correlation between AAA and ESRD even after adjusting for several health conditions. This discovery suggests the need for regular monitoring of AAA patients. This proactive approach can aid in promptly identifying signs of ESRD and addressing modifiable risk factors at an early stage through timely interventions.
Chronic kidney disease (CKD) is defined as an abnormality of kidney function, present for > 3 months, with negative effects on health. Glomerular filtration rate (GFR) is often used as an indicator of renal function. CKD is the diagnosis when the GFR is < 60>
An abdominal aortic aneurysm (AAA) refers to a persistent dilatation of the abdominal aorta that surpasses the standard diameter by 50% or more than 3 cm. In Western populations, the average yearly occurrence of new AAA diagnoses is 0.4-0.67%.4 The current guidelines recommend considering surgical intervention for symptomatic and large asymptomatic fusiform AAAs. In this context, large is defined as a maximum diameter ≥ 55 mm in men and ≥ 50 mm in women.5 However, most asymptomatic AAAs are discovered through screening or incidentally during the diagnosis of other conditions.6 When discovered through screening, the majority of AAA are 4.5 cm or less.7
Oliver-Williams et al.8 determined an AAA mean growth rate of 0.26 (0.25-0.28) cm/year in the first five years in men, with an initial AAA of 3.0-5.4 cm that increased to 0.80 (0.73-0.86) cm/year after 15-19 years. Therefore, even if patients are under surveillance, the condition may progress to a stage that requires surgical treatment. The odds ratio of mortality for patients receiving chronic renal replacement therapy was 4.0 when undergoing vascular surgery compared to that of patients with normal renal function.9 This trend was also present with endovascular treatment.10,11 Therefore, it is important to identify an association between AAA and ESRD to prevent ESRD.
This research tested the hypothesis that a correlation exists between AAA and ESRD. We used data from the Korean National Health Insurance Service (NHIS) database that spanned seven years.
This study is a parallel study to “Risk of various cancers in adults with abdominal aortic aneurysm” and “The risk of dementia in adults with abdominal aortic aneurysm” by Cho et al.12,13 We used similar study protocols, patient group selection methods, and statistical methods.
Data source
The NHIS serves as the sole public medical insurance system in South Korea, providing coverage to approximately 97% of the country's 50 million citizens. The remaining 3% receive coverage through Medical Aid.14 As part of its services, the NHIS offers a health examination program every two years for all insured individuals aged 40 and above and for employee subscribers aged 20 and older. Additionally, the NHIS maintains an extensive dataset of medical records in Korea. These records include patient demographics, medical treatments, procedures, and disease diagnoses following the 10th edition of the International Classification of Diseases (ICD-10). For this study, data from the NHIS database spanning the years 2009 to 2015 were collected.
Study population
Between January 2009 and December 2015, a total of 45,767 individuals was diagnosed with AAA using the appropriate ICD-10 code. Cases of AAA were determined by identifying individuals with multiple instances of AAA diagnosis codes I71.3-I71.6, I71.8, and I71.9 within the previous year at outpatient departments, those who had experienced repeated hospitalizations with these codes, or individuals who had undergone aneurysm repair such as open surgical aneurysmal repair (OSAR) or endovascular aneurysmal repair (EVAR). These surgical repair procedures are indicated by ICD-10 codes of O0223, O0224, O0234, M6611, or M6612. Exclusions were applied to patients who had not undergone a health examination within two years before the diagnosis of AAA (n = 26,123), those aged under 20 years (n = 195), or those with incomplete data (n = 219). Although we intended to exclude patients who had been diagnosed with ESRD prior to their AAA diagnosis, no such cases were found. From the remaining patients, a subset of individuals with greater than one year between the diagnosis of AAA and ESRD was chosen. Therefore, the analysis included 16,671 AAA patients who were matched with 50,013 controls (1:3 ratio) using propensity score matching based on age and sex (Figure 1). The observation period concluded in December 2019. The primary objective of this study was to identify newly diagnosed cases of ESRD. This study was conducted with approval from the Institutional Review Board of The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Seoul, Korea (PC24ZASI0037).
Figure 1: Enrollment flow chart
AAA: abdominal aortic aneurysm, ESRD: end-stage renal disease
Figure 2: Kaplan–Meier plot for incidence of ESRD in patients with AAA.
AAA: abdominal aortic aneurysm, ESRD: end-stage renal disease
The upper graph illustrates the incidence of ESRD between the AAA group and the control group. The lower graph shows the incidence of ESRD divided among the control group, the group that underwent surgery for AAA, and the group that received non-surgical treatment.
Definitions of ESRD and other covariates
ESRD patients were identified using rare incurable disease codes of V001 (hemodialysis), V003 (peritoneal dialysis), and V005 (kidney transplantation). For CKD, the criterion was the scientifically appropriate estimated GFR measured during routine health examinations. The estimated GFR is calculated using the Modification of Diet in Renal Disease (MDRD) equation; the threshold was defined as less than 60.
Smoking status was categorized as non-smoker, ex-smoker, or current smoker. Alcohol consumption status was categorized as non-drinker, mild-to-moderate drinker (average consumption < 30>
Statistical analysis
For comparing baseline characteristics, Student’s t-tests were employed for continuous variables, and chi-square or Fisher’s exact tests were used for categorical variables. The incidence rates of ESRD are presented per 1,000 person-years. Multivariate Cox proportional hazard regression analyses were performed to evaluate the association between ESRD and AAA.
The hazard ratio (HR) was not adjusted in model 1. Model 2 was adjusted for age; sex; income level; and presence of diabetes, hypertension, and dyslipidemia. In model 3, additional variables of smoking status, alcohol consumption, exercise habits, and BMI were incorporated and adjusted.
Model 4 additionally adjusted for a history of CVD and the presence of CKD. Statistical significance was set at p < 0>
Baseline characteristic
Dyslipidemia and hypertension are recognized as key risk factors for AAA, and these conditions were more commonly observed in the AAA group. Additionally, the AAA group exhibited a higher proportion of smokers and those with elevated BMI and greater waist circumference. Physical activity was notably lower among members of the AAA group, and their alcohol consumption was relatively lower. The proportion of low-income participants in this group was relatively lower. Within the AAA group, there was a greater incidence of patients with DM and individuals with a history of CVD. Significantly more patients with CKD were observed in the AAA group; this corresponded to a reduced eGFR (Table 1)
Table 1: Clinical characteristics of control and abdominal aortic aneurysm (AAA) patients.
ESRD risk according to AAA
In a study population of 66,684 participants, 379 (0.56%) developed ESRD. Compared to the control group, the AAA group had a higher risk of ESRD in the unadjusted model, with HR 4.33 (95% CI 3.53-5.31), and also in the fully-adjusted model with HR 2.51 (95% CI 2.0-3.16). In the AAA group, when divided into surgical and non-surgical subgroups, the surgical subgroup had a significantly higher HR (Table 2-1). These results were easily confirmed through the Kaplan-Meier plot, in which the AAA group showed significantly higher incidence probability of ESRD than the control group (Figure 2). This difference was significant as the p-value was less than 0.05 (p-value <0>
Additionally, a more detailed subgroup analysis was conducted based on the presence of proteinuria and CKD. In the unadjusted model, the HRs for ESRD onset were 4.79 (95% CI: 1.69-13.54) for those with proteinuria only, 11.81 (95% CI: 7.72-18.08) for those with CKD only, and 180.39 (95% CI: 118.36-274.91) for those with both conditions. In the fully-adjusted model, these HRs were 3.15 (95% CI: 1.11-8.93), 86 (95% CI: 5.57-13.26), and 86.64 (95% CI: 55.82-134.5), respectively. Moreover, when AAA was present with these conditions, the incidence of ESRD increased dramatically; the fully adjusted model had an HR of 128.66 (95% CI: 81.58-202.9) (Table 2-2).
Interactions with AAA on occurrence of ESRD
In studying the onset of ESRD, we identified variables that interact synergistically with AAA. Among various factors, only the presence of diabetes mellitus (DM), chronic kidney disease (CKD), and proteinuria showed significant interactions, all of which were negative. This implies that the combined effect of AAA with any of these conditions on the risk of developing ESRD is less than would be expected from their individual impacts [1.64 vs. 3.76 (DM), 2.26 vs. 3.39 (CKD), 1.78 vs. 3.01 (proteinuria)] (Table 3) (p-vaule : <0>AAA N Event Duration Rate Model 1 Model 2 Model 3 Model 4 No 50,013 166 235,023.07 0.70631 1 1 1 1 Yes 16,671 213 69,842.43 3.04972 4.33(3.53,5.31) 3.26(2.63,4.01) 3.13(2.53,3.87) 2.51(2.0,3.16) AAA group divided into surgical and non-surgical groups (Reference : control group) No 50,013 166 235,023.07 0.70631 1 1 1 1 Non-surgical 12,250 112 53,443.82 2.09566 2.98(2.34,3.78) 2.51(1.96,3.21) 2.45(1.91,3.13) 2.01(1.55,2.61) Surgical 4,421 101 16,398.62 6.15906 8.79(6.86,11.27) 4.97(3.83,6.44) 4.77(3.66,6.21) 3.65(2.77,4.82) AAA group divided into surgical and non-surgical groups (Reference : non-surgical group) No 50,013 166 235,023.07 0.70631 0.34(0.26,0.43) 0.4(0.31,0.51) 0.41(0.32,0.52) 0.50(0.38,0.65) Non-surgical 12,250 112 53,443.82 2.09566 1 1 1 1 Surgical 4,421 101 16,398.62 6.15906 2.95(2.26,3.87) 2.0(1.51,2.60) 1.95(1.48,2.57) 1.82(1.38,2.4)
Table 2-1. Hazard ratio of AAA for incidence of ESRD.
AAA: abdominal aortic aneurysm, ESRD: end-stage renal disease
Rate: incidence rate per 1,000 person-years
Model 1: non-adjusted. Model 2: adjusts for basic demographics and health conditions, including age; sex; income level; and the presence of diabetes, hypertension, and dyslipidemia. Model 3: includes all factors from Model 2 and further adjusts for lifestyle factors of smoking status, alcohol consumption, exercise status, and body mass index (BMI). Model 4: builds on Model 3, adding adjustments for a history of cardiovascular disease (CVD) and the presence of chronic kidney disease (CKD).
| CKD | UPRO | AAA | N | Event | Model 1 | Model 2 | Model 3 | Model 4 |
| No | No | No | 41,308 | 32 | 1(Ref.) | 1(Ref.) | 1(Ref.) | 1(Ref.) |
| No | Yes | No | 1,080 | 4 | 4.79(1.69,13.54) | 3.15(1.1,8.83) | 3.14(1.11,8.9) | 3.15(1.11,8.93) |
| Yes | No | No | 7,059 | 63 | 11.81(7.72,18.08) | 8.74(5.67,13.48) | 8.65(5.61,13.33) | 8.6(5.57,13.26) |
| Yes | Yes | No | 566 | 67 | 180.39(118.36,274.91) | 89.79(57.94,139.14) | 86.15(55.51,133.70) | 86.64(55.82,134.5) |
| No | No | Yes | 12,391 | 44 | 5.04(3.2,7.95) | 3.9(2.46,6.19) | 3.80(2.39,6.05) | 3.48(2.18,5.57) |
| No | Yes | Yes | 514 | 12 | 33.86(17.44,65.75) | 19.56(10.0,38.28) | 19.17(9.77,37.61) | 17.6(8.93,34.7) |
| Yes | No | Yes | 3,369 | 95 | 45.89(30.73,68.51) | 28.99(19.17,43.85) | 27.89(18.41,42.26) | 25.49(16.68,38.96) |
| Yes | Yes | Yes | 397 | 62 | 288.95(188.49,442.97) | 146.16(93.78,227.78) | 139.87(89.52,218.54) | 128.66(81.58,202.9) |
Table 2-2. Hazard ratio of AAA for incidence of ESRD. (Further analysis)
AAA: abdominal aortic aneurysm, ESRD: end-stage renal disease, CKD: chronic kidney disease, UPRO: urine protein (≥ 1+ dipstick proteinuria)
Model 1: non-adjusted. Model 2: adjusts for basic demographics and health conditions, including age; sex; income level; and the presence of diabetes, hypertension, and dyslipidemia. Model 3: includes all factors from Model 2 and further adjusts for lifestyle factors of smoking status, alcohol consumption, exercise status, and body mass index (BMI). Model 4: builds on Model 3, adding adjustments for a history of cardiovascular disease (CVD) and the presence of chronic kidney disease (CKD).
Table 3: Subgroup analysis for interactions of AAA and ESRD
AAA: abdominal aortic aneurysm, ESRD: end-stage renal disease, CKD: chronic kidney disease, UPRO: urine protein (≥ 1+ dipstick proteinuria)
Rate: Incidence rate per 1000 person years
Model is adjusted for age; sex;fd income level; presence of diabetes, hypertension, and dyslipidemia; smoking status; alcohol consumption; exercise status; BMI; history of CVD; and presence of CKD.
Most research on the relationship between AAA and renal function has focused on the relationships between treatments for AAA and renal function. For example, OSAR and EVAR were both associated with acute kidney injury (AKI); and the incidence of AKI was higher in the OSAR group.15,16 Factors affecting this relationship included preoperative hemoglobin level and eGFR, operation duration, history of cardiovascular disease, and amount of bleeding and transfusion.17 However, unlike AKI, there was no significant difference in the incidence of postoperative CKD between OSAR and EVAR from one to five years after surgery.18–21 Age > 70 years, renal artery stenosis (RAS) ≥ 70%, peri-procedural AKI, graft complications, larger neck diameter, and angio-CT followed by stent-graft implantation over a short time interval were independent risk factors for CKD.18,21–23 In this study, the HR of ESRD was significantly higher in the surgical group compared with the non-surgical group [HR: 1.82 (95% CI 1.38-2.4)].
However, the association between AAA and ESRD required more attention. In this regard, Barisione et al.24 provided clues for the increased CKD and cardiac damage risk profiles of AAA patients. The reason that this relationship is important is that the size of AAAs increases gradually. As shown by Olson et al.,25 26% of patients with a maximum transverse diameter of at least 4.25 cm exceeded sex-specific repair thresholds (5.5 cm for men and 5.0 cm for women) at two years. A significant number of patients under surveillance for AAA eventually required surgery. Therefore, an ESRD prevalence higher in AAA patients compared to a control group has significant clinical implications. First, the prognosis is better for those with an early CKD diagnosis who are provided appropriate treatment. This recognizes the potential for declining renal function in AAA patients, and active monitoring can help preserve kidney function in the long term. Second, since a significant number of patients under surveillance for AAA eventually undergoes surgery and ESRD has been reported as a major factor affecting outcomes in AAA surgery, focusing on preserving renal function in AAA patients can potentially improve the surgical and post-surgical outcomes.26
The results of the subgroup analysis showed that the presence of CKD increases the likelihood of developing ESRD, and this was also true for the proteinuria group. AAA patients with proteinuria require particular attention. Proactive surveillance is necessary for these patients. Of course, one reason for these findings may be that surveillance in the AAA group often involves the use of contrast agents for CT scans or that renal function can be impaired due to surgical interventions. However, this is not always the case since Table 2 demonstrates that, even in the non-surgical subgroup, the prevalence of ESRD was higher in the AAA group compared to the control group.
DM, CKD, and proteinuria are significantly associated with and are risk factors for ESRD.27 Indeed, ESRD incidence increases when these conditions coexist with AAA. However, the reason these factors exhibit a negative interaction effect may be that the impact these variables have on ESRD shares common mechanisms with AAA influence on the onset of ESRD. This overlap might result in a lower relative contribution of AAA.
The study has some limitations. First, the observational design of our study restricts our ability to infer a causal relationship. To mitigate this limitation as much as possible, we only enrolled patients who had a one-year time lag; and we utilized a Cox proportional hazards regression model to approximate as closely as possible the direct associations with the variables.
Additionally, even if we strive to accurately estimate the associations between variables, our definitions for ESRD and the AAA patient group may lack precision since they were identified using disease codes. Second, the mean eGFR values of the AAA group and the control group were significantly different, although the eGFR values were in the same category (G2; 60-89 mL/min/1.73m2). The values were 75.39 for the AAA group and 79.51 for the control group. This could have been a natural result because there were many CKD patients in the AAA group, but this difference may have created a bias. Third, in this study, because the incidence of ESRD was low, careful interpretation of the results is necessary. The small number of events may have affected the statistical power and reliability of the results, which may limit the generalizability of our findings. Therefore, larger-scale studies with a greater number of events are needed in the future. Fourth, since the study was conducted only on Koreans, the effect of race could not be analyzed.
Nevertheless, our study possesses several strengths. First, we established a connection between AAA and ESRD, a relationship not explored in previous research. Second, our research utilized a substantial national dataset coupled with an extensive follow-up duration. Third, we examined the effect of the coexistence of CKD and proteinuria on the relationship between AAA and ESRD and analyzed interactions among several variables.
Through this research, we identified a high incidence of ESRD among AAA patients, highlighting the necessity of meticulous renal function monitoring during the treatment or surveillance of this patient group. Moreover, the particular attention required by patients with existing CKD or proteinuria has been highlighted as these conditions significantly increase the prevalence of ESRD. Ultimately, our suggestions will not only help preserve renal function in patients, but also positively influence the outcomes of AAA treatment, especially after surgery
None of the authors have anything to disclose.
None declared.
This research was supported by a grant funded by The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Research Institute of Medical Science in program year 2023.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
