Reviewer's report 
 Urodilatin Increases Natriuresis in Cirrhosis Patients with Sodium Retention. Title: 
 1  22 August 2006 Version: Date: 
 Yasuhiko Sugawara Reviewer: 
Reviewer's report: 
General comment 
The manuscript entitled “Urodilatin increases natriuresis in cirrhotic patients with sodium retention” by 
Carstens et al. presents important data on the diuretic effects of synthetic urodilatin intravenous administration in patients with decompressed cirrhosis. Considering the small sample size and the data presented in this study, the title ” Urodilatin increases natriuresis” might be too affirmative and should be 
changed. The study design is well prepared and the finding has potential help for the management of 
decompressed cirrhotic patients. 
Specific comments 
1. The table which summarizes patients’ basal characteristics including ranal and liver exams, urinary 
analysis, and endogenous urodilatin and other hormones (such as renin, angiotensin, aldosterone..)level should be prepared. 2. The transition of the total amount of Na excretion should also be analyzed and presented in figure. 
3. page7, first paragraph. “By the end of infusions there was no difference between Uro and placebo” might 
be incorrect. From the Fig.2 the difference seemed disappear at the end of the study. 
4. The transition of serum urodilation level under URO and placebo had better to be presented in figure, if available. 
5. Is serum urodilatin level of decompressed cirrhotic patients usually elevated or not when compared to 
normal population? ANP, one of the family of natriuretic peptide, usually up-regulated in advanced cirrhosis 
and the decreased response to ANP has been advocated to be one of the reasons of the unresponsiveness 
to ANP infusion in such patients. Is this the case with urodilatin? 
6. The clinical application and limitation of urodilatin for cirrhotic patients should be discussed in association 
with other diseases such as chronic heart failure in which the clinical value of urodilation has been reported. 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Reviewer's report 
 Urodilatin Increases Natriuresis in Cirrhosis Patients with Sodium Retention. Title: 
 1  22 August 2006 Version: Date: 
 Yasuhiko Sugawara Reviewer: 
Reviewer's report: 
General comment 
The manuscript entitled “Urodilatin increases natriuresis in cirrhotic patients with sodium retention” by 
Carstens et al. presents important data on the diuretic effects of synthetic urodilatin intravenous administration in patients with decompressed cirrhosis. Considering the small sample size and the data presented in this study, the title ” Urodilatin increases natriuresis” might be too affirmative and should be 
changed. The study design is well prepared and the finding has potential help for the management of 
decompressed cirrhotic patients. 
Specific comments 
1. The table which summarizes patients’ basal characteristics including ranal and liver exams, urinary 
analysis, and endogenous urodilatin and other hormones (such as renin, angiotensin, aldosterone..)level should be prepared. 2. The transition of the total amount of Na excretion should also be analyzed and presented in figure. 
3. page7, first paragraph. “By the end of infusions there was no difference between Uro and placebo” might 
be incorrect. From the Fig.2 the difference seemed disappear at the end of the study. 
4. The transition of serum urodilation level under URO and placebo had better to be presented in figure, if available. 
5. Is serum urodilatin level of decompressed cirrhotic patients usually elevated or not when compared to 
normal population? ANP, one of the family of natriuretic peptide, usually up-regulated in advanced cirrhosis 
and the decreased response to ANP has been advocated to be one of the reasons of the unresponsiveness 
to ANP infusion in such patients. Is this the case with urodilatin? 
6. The clinical application and limitation of urodilatin for cirrhotic patients should be discussed in association 
with other diseases such as chronic heart failure in which the clinical value of urodilation has been reported. 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
Please review this paper.
user
Reviewer's report 
 Urodilatin Increases Natriuresis in Cirrhosis Patients with Sodium Retention. Title: 
 1  22 August 2006 Version: Date: 
 Yasuhiko Sugawara Reviewer: 
Reviewer's report: 
General comment 
The manuscript entitled “Urodilatin increases natriuresis in cirrhotic patients with sodium retention” by 
Carstens et al. presents important data on the diuretic effects of synthetic urodilatin intravenous administration in patients with decompressed cirrhosis. Considering the small sample size and the data presented in this study, the title ” Urodilatin increases natriuresis” might be too affirmative and should be 
changed. The study design is well prepared and the finding has potential help for the management of 
decompressed cirrhotic patients. 
Specific comments 
1. The table which summarizes patients’ basal characteristics including ranal and liver exams, urinary 
analysis, and endogenous urodilatin and other hormones (such as renin, angiotensin, aldosterone..)level should be prepared. 2. The transition of the total amount of Na excretion should also be analyzed and presented in figure. 
3. page7, first paragraph. “By the end of infusions there was no difference between Uro and placebo” might 
be incorrect. From the Fig.2 the difference seemed disappear at the end of the study. 
4. The transition of serum urodilation level under URO and placebo had better to be presented in figure, if available. 
5. Is serum urodilatin level of decompressed cirrhotic patients usually elevated or not when compared to 
normal population? ANP, one of the family of natriuretic peptide, usually up-regulated in advanced cirrhosis 
and the decreased response to ANP has been advocated to be one of the reasons of the unresponsiveness 
to ANP infusion in such patients. Is this the case with urodilatin? 
6. The clinical application and limitation of urodilatin for cirrhotic patients should be discussed in association 
with other diseases such as chronic heart failure in which the clinical value of urodilation has been reported. 
 Accept after minor essential revisions What next?: 
 An article whose findings are important to those with closely related research interests Level of interest: 
 Acceptable Quality of written English: 
 No Statistical review: 
assistant