Quality of Reporting and Study Design of CKD Cohort Studies Assessing Mortality in the Elderly Before and After STROBE: A Systematic Review

PLoS One. 2016 May 11;11(5):e0155078. doi: 10.1371/journal.pone.0155078. eCollection 2016.


Background: The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement was published in October 2007 to improve quality of reporting of observational studies. The aim of this review was to assess the impact of the STROBE statement on observational study reporting and study design quality in the nephrology literature.

Study design: Systematic literature review.

Setting & population: European and North American, Pre-dialysis Chronic Kidney Disease (CKD) cohort studies.

Selection criteria for studies: Studies assessing the association between CKD and mortality in the elderly (>65 years) published from 1st January 2002 to 31st December 2013 were included, following systematic searching of MEDLINE & EMBASE.

Predictor: Time period before and after the publication of the STROBE statement.

Outcome: Quality of study reporting using the STROBE statement and quality of study design using the Newcastle Ottawa Scale (NOS), Scottish Intercollegiate Guidelines Network (SIGN) and Critical Appraisal Skills Programme (CASP) tools.

Results: 37 papers (11 Pre & 26 Post STROBE) were identified from 3621 potential articles. Only four of the 22 STROBE items and their sub-criteria (objectives reporting, choice of quantitative groups and description of and carrying out sensitivity analysis) showed improvements, with the majority of items showing little change between the period before and after publication of the STROBE statement. Pre- and post-period analysis revealed a Manuscript STROBE score increase (median score 77.8% (Inter-quartile range [IQR], 64.7-82.0) vs 83% (IQR, 78.4-84.9, p = 0.05). There was no change in quality of study design with identical median scores in the two periods for NOS (Manuscript NOS score 88.9), SIGN (Manuscript SIGN score 83.3) and CASP (Manuscript CASP score 91.7) tools.

Limitations: Only 37 Studies from Europe and North America were included from one medical specialty. Assessment of study design largely reliant on good reporting.

Conclusions: This study highlights continuing deficiencies in the reporting of STROBE items and their sub-criteria in cohort studies in nephrology. There was weak evidence of improvement in the overall reporting quality, with no improvement in methodological quality of CKD cohort studies between the period before and after publication of the STROBE statement.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Cohort Studies
  • Humans
  • Linear Models
  • Observational Studies as Topic*
  • Observer Variation
  • Renal Insufficiency, Chronic / mortality*
  • Research Design*
  • Research Report*

Grant support

This work was part-funded by the UK Renal Registry (https://www.renalreg.org/) and forms part of AR’s Doctorate of Philosophy (PhD) thesis. It was also part-funded by the European Community's Seventh Framework Programme under grant agreement number HEALTH-F2-2009-241544 (SysKID) (K.B., V.S.S., K.J.J.), and the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA-www.era-edta.org/) under the Quality European Studies initiative (K.B.). Additionally, this article was co-written by V.S.S and K.J.J on behalf of the ERA-EDTA Registry which is an official body of the ERA-EDTA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.