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

Export contracts for non-traditional products: Chayote from Costa Rica

This paper focuses on the determinants of market and contract choice for non-traditional crops and the possibilities for involving local producers in global agro-food chains through delivery relationships with packers and brokers. Main attention is given to the importance of quality for entering the export market and the impact of contractual arrangements on loyal behaviour. Core stipulations in the contract regarding the frequency of delivery and the provision of technical assistance are mediating factors between quality and loyalty. The study among traditional and recently established producers of chayote in Costa Rica confirms the importance of production scale and experience for engagement in exports. The export share is positively related to quality performance but inversely related to delivery frequency and sales at the local market. Apparently, traditional producers rely on market diversification to maintain a certain bargaining power vis-à-vis traders and processors. Verbal contractual arrangements are mainly offered to newly established but less-experienced farmers living in settlements that try to reduce risk and demonstrate a high commitment. These farmers cultivate on better soils and have more family labour available. Further quality improvement requires technical assistance and a high frequency of delivery. Supplier arrangements that guarantee timely collection, input support and flexible credit services are therefore of critical importance. Additional support from packers and exporters could enable farmers to improve product quality and is likely to be rewarded. with a high degree of loyalty

Effects of oral iodine supplementation in very low birth weight preterm infants for the prevention of thyroid function alterations during the neonatal period: results of a randomised assessor-blinded pilot trial and neurodevelopmental outcomes at 24 months

The trace element iodine (I) is essential for the synthesis of thyroid hormones. Parenteral nutrition solutions, formula milk, and human breast milk contain insufficient iodine to meet recommended intake for preterm infants. Iodine deficiency may affect thyroid function and may be associated with morbidity or neurological outcomes. The primary objective is to assess the evidence that dietary supplementation with iodine affects thyroid function during the neonatal period. The design was a randomised controlled pilot trial. Infants who met the inclusion criteria were enrolled through consecutive sampling and assigned to two different groups. The setting was a Spanish university hospital. Ninety-four patients with very low birth weight (under 1500 g) were included. Intervention group: 30 µg I/kg/day of iodine in oral drops given to 47 infants from their first day of life until hospital discharge. Control group: 47 infants without supplements. Formula and maternal milk samples for the determination of iodine content were collected at 1, 7, 15, 21, 30 days, and at discharge. Blood samples were collected for thyroid hormones. Neurological development was assessed at 2 years of age (Bayley III Test). Infants in the supplemented group reached the recommended levels from the first days of life. The researchers detected the effects of iodine balance on the plasma levels of thyroid hormones measured during the first 12 weeks of age. The trial assessed the impact of the intervention on neurodevelopmental morbidity

Transporte de humedad y variaciones estacionales en la composición isotópica estable de la lluvia en el páramo centroamericano y andino durante las condiciones de El Niño (2015-2016)

Los sistemas de pastizales tropicales de gran altitud, llamados Páramo, brindan servicios ecosistémicos esenciales como el almacenamiento y el suministro de agua para las áreas circundantes y de tierras bajas. Los sistemas de páramo están amenazados por los cambios climáticos y de uso del suelo. Los procesos de generación de lluvia y las vías de transporte de humedad que influyen en la precipitación en el Páramo no se conocen bien, pero se necesitan para estimar el impacto de estos cambios, particularmente durante las condiciones de El Niño, que afectan en gran medida las condiciones hidrometeorológicas en las regiones tropicales. Para llenar este vacío de conocimiento, presentamos un análisis de isótopos estables de las muestras de lluvia recolectadas diariamente o semanalmente entre enero de 2015 y mayo de 2016 durante el evento de El Niño más fuerte registrado en la historia (2014-2016) en dos regiones de Páramo de América Central (Chirripó, Costa Rica) y el norte de los Andes (Cajas, sur de Ecuador). Se utilizaron composiciones isotópicas para identificar cómo los procesos de generación de lluvia (convectiva y orográfica) cambian estacionalmente en cada sitio de estudio. Se usó el análisis de trayectoria de masa de aire híbrido de modelo de trayectoria integrada lagrangiana de partícula única (HYSPLIT) para identificar rutas preferenciales de transporte de humedad a cada sitio de Páramo. Nuestros resultados muestran la fuerte influencia de los vientos alisios del noreste para transportar la humedad del Mar Caribe a Chirripó y el jet sudamericano de bajo nivel para transportar la humedad del bosque amazónico a Cajas. Estas contribuciones de humedad también se relacionaron con la formación de lluvia convectiva asociada con el paso de la Zona de Convergencia Intertropical sobre Costa Rica y Ecuador durante las estaciones más húmedas y con la precipitación orográfica durante las temporadas de transición y más secas. Nuestros hallazgos brindan información básica esencial para futuras aplicaciones de investigación de isótopos estables al agua como trazadores de procesos de generación de lluvia y transporte en el Páramo y otros ecosistemas montanos en los trópicos.High‐elevation tropical grassland systems, called Páramo, provide essential ecosystem services such as water storage and supply for surrounding and lowland areas. Páramo systems are threatened by climate and land use changes. Rainfall generation processes and moisture transport pathways influencing precipitation in the Páramo are poorly understood but needed to estimate the impact of these changes, particularly during El Niño conditions which largely affect hydrometeorological conditions in tropical regions. To fill this knowledge gap, we present a stable isotope analysis of rainfall samples collected on a daily to weekly basis between January 2015 and May 2016 during the strongest El Niño event recorded in history (2014‐2016) in two Páramo regions of Central America (Chirripó, Costa Rica) and the northern Andes (Cajas, south Ecuador). Isotopic compositions were used to identify how rainfall