The uptake of the current concept of chronic kidney disease (CKD) by the public, physicians and health authorities is low. Physicians still mix up CKD with chronic kidney insufficiency or failure. In a recent manuscript, only 23% of participants in a cohort of persons with CKD had been diagnosed by their physicians as having CKD while 29% has a diagnosis of cancer and 82% had a diagnosis of hypertension. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. A prevalent view is that for those in whom kidneys fail, the problem is "solved" by dialysis or kidney transplantation. However, the main burden of CKD is accelerated aging and all-cause and cardiovascular premature death. CKD is the most prevalent risk factor for lethal COVID-19 and the factor that most increases the risk of death in COVID-19, after old age. Moreover, men and women undergoing KRT still have an annual mortality which is 10-100-fold higher than similar age peers, and life expectancy is shortened by around 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 global cause of death by 2040 and the second cause of death in Spain before the end of the century, a time when 1 in 4 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 CIBER network research structure in Spain. Leading Spanish kidney researchers grouped in the kidney collaborative research network REDINREN have now applied for the RICORS call of collaborative research in Spain with the support of the Spanish Society of Nephrology, ALCER and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true. However, only the highest level of research funding through the CIBER will allow to adequately address the issue before it is too late. (C) 2021 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U.

•El paciente trasplantado renal va a requerir de unos cuidados especiales durante su seguimiento. Dichos cuidados son llevados a cabo de forma habitual por los nefrólogos de las unidades de trasplante, pero hay diversos aspectos que los médicos de atención primaria deben conocer.•Debido a la necesidad de un tratamiento de larga duración con diversos fármacos que tienen toxicidades específicas, es frecuente la no adherencia al tratamiento inmunosupresor con las consecuencias deletéreas que ello tiene para la viabilidad del injerto a largo plazo. Es recomendable una estrecha colaboración entre el médico de atención primaria y el equipo de trasplante para facilitar la detección precoz de este problema y su abordaje.•La pielonefritis del injerto es la primera causa de ingreso hospitalario durante los primeros 12 meses. No es recomendable el tratamiento de la infección urinaria sin disponer de un urocultivo previo para caracterizar el germen y su sensibilidad a los antibióticos dada la elevada prevalencia de gérmenes multirresistentes.•El riesgo cardiovascular está muy aumentado en los pacientes con enfermedad renal crónica terminal y la mejor opción para disminuirlo es que reciban un trasplante renal. El control de los factores clásicos (tabaquismo, hipertensión arterial, dislipemia, diabetes, obesidad y sedentarismo) debe ser lo más estricto posible para minimizar dicho riesgo.•En los pacientes trasplantados renales, la incidencia acumulada de neoplasias es muy elevada, especialmente el riesgo de cáncer de piel no melanoma. Por lo tanto, es recomendable minimizar la exposición solar y aplicar cremas con factor de protección elevado.•Las causas más frecuentes de fracaso del injerto son la muerte del paciente con injerto funcionante (50%) y la disfunción crónica del injerto (50%). Esta última se halla en relación con el rechazo crónico (30-50% de los casos), en muchos casos favorecido por una inadecuada adherencia al tratamiento inmunosupresor.

Background: In many centers patients are hospitalised to perform a renal allograft biopsy. Aim: To evaluate the safety and efficacy of outpatient renal allograft biopsies. Methods: Since December 2011 we perform renal allograft biopsies as an outpatient procedure. Exclusion criteria for performing an outpatient biopsy included: 1.) anticoagulant treatment, 2.) thrombocytopenia <50,000/mm(3), 3.) body mass index >35kg/m(2) and 4.) uncontrolled hypertension. The number and severity of complications were compared with an historical cohort of 124 biopsies done between 2007 and 2011 when all patients were hospitalised for the procedure and with 42 patients biopsied during hospitalisation between 2011 and 2013. Results: Between 2011 and 2013, 210 (95%) out of 230 biopsies indicated in the outclinic were performed as an outpatient procedure (95%). The incidence of major complications (bleeding requiring blood transfusion and/or embolisation) was 0.8% between 2007 and 2011 and 2.4% in biopsies between 2011 and 2013 in hospitalised patients (p=0.475). No major complications were observed in the outpatient biopsy group. Minor complications (hematuria, hematoma or fistula not requiring transfusion or embolisation) were also not different between groups (3.2%, 7.1% and 2.7%; respectively). Sample size adequacy according to the Banff criteria was not different among groups (p=0.052). Conclusion: Ambulatory renal allograft biopsy is a safe and efficient procedure.