RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

A case study of an individual participant data meta-analysis of diagnostic accuracy showed that prediction regions represented heterogeneity well

The diagnostic accuracy of a screening tool is often characterized by its sensitivity and specificity. An analysis of these measures must consider their intrinsic correlation. In the context of an individual participant data meta-analysis, heterogeneity is one of the main components of the analysis. When using a random-effects meta-analytic model, prediction regions provide deeper insight into the effect of heterogeneity on the variability of estimated accuracy measures across the entire studied population, not just the average. This study aimed to investigate heterogeneity via prediction regions in an individual participant data meta-analysis of the sensitivity and specificity of the Patient Health Questionnaire-9 for screening to detect major depression. From the total number of studies in the pool, four dates were selected containing roughly 25%, 50%, 75% and 100% of the total number of participants. A bivariate random-effects model was fitted to studies up to and including each of these dates to jointly estimate sensitivity and specificity. Two-dimensional prediction regions were plotted in ROC-space. Subgroup analyses were carried out on sex and age, regardless of the date of the study. The dataset comprised 17,436 participants from 58 primary studies of which 2322 (13.3%) presented cases of major depression. Point estimates of sensitivity and specificity did not differ importantly as more studies were added to the model. However, correlation of the measures increased. As expected, standard errors of the logit pooled TPR and FPR consistently decreased as more studies were used, while standard deviations of the random-effects did not decrease monotonically. Subgroup analysis by sex did not reveal important contributions for observed heterogeneity; however, the shape of the prediction regions differed. Subgroup analysis by age did not reveal meaningful contributions to the heterogeneity and the prediction regions were similar in shape. Prediction intervals and regions reveal previously unseen trends in a dataset. In the context of a meta-analysis of diagnostic test accuracy, prediction regions can display the range of accuracy measures in different populations and settings

Métodos de proteção de mudas de abacate contra geada em diferentes cultivares Frost protection covers methods for avocado in different cultivars

Este trabalho foi realizado na EMBRAPA Transferência de Tecnologia/SNT, localizado em Canoinhas-SC, Planalto Norte Catarinense. O objetivo foi avaliar a tolerância ao frio de oito cultivares de abacate (Choquette, Vitória, Herculano, Quintal, Linda, Tonnage, Fuerte e Ryan) plantadas em maio de 2003, utilizando dois métodos de proteção da muda contra geadas (galhos de eucalipto e galhos de eucalipto + sombrite). Em setembro do mesmo ano, estes materiais que protegiam as mudas, foram retirados e foram atribuídas notas para avaliar o grau de dano nas plantas. Não houve diferença entre as cultivares de abacate em relação à tolerância ao frio, independentemente do tipo de proteção. Entretanto, comparados os dois métodos avaliados, a utilização de galhos de eucalipto associado ao uso de sombrite foi mais eficiente na proteção de plantas jovens de abacate quando comparado ao uso de galhos de eucalipto.<br>The experiment was carried out at EMBRAPA Technology Transfer Office at Canoinhas, Santa Catarina State, Northern Highland area. The aim was to evaluate the tolerance for low temperature in eight varieties of avocado (Choquette, Vitória, Herculano, Quintal, Linda, Tonnage, Fuerte and Ryan) planted in May of 2003 using two methods of covers for avocado maiden trees (eucalyptus branches and eucalyptus branches plus sombrite). In September, in the same year, the covers were removed and ranked by scores to evaluate the degree of frost injury on plants. There were no difference between avocado varieties in relation of covers methods. However, comparing the two covers methods, the use of eucalyptus branches plus sombrite was better than the use of eucalyptus branches, in young plants of avocado