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 mix up 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 aging 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 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 which is 10- o 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. 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 (AAKP) and the European Kidney Health Alliance (EKHA). 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.

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Anastomotic leaks after roux-en Y gastric bypass for morbid obesityBackground: Obesity is a severe disease whose prevalence continues to increase. Resective gastric bypass is one of the surgical procedures used in our center in patients with obesity, but like other techniques is not without complications, and the leak is one of the most serious. The use of drains and leak test with methylene blue during surgery, such as barium x-ray were performed in all patients as part of a protocol. Clinical signs, development, testing and treatment were recorded. Results: 36 patients (4%) developed leaks. Of the 900 patients died 3 (0.33%). Fever and tachycardia were the predominant symptoms. The diagnosis was made by imaging studies in 19 cases (52.7%). The leaks were mostly between 5 th and 9 th postoperative day. The most frequent location of the leak was at the gastrojejunal anastomosis (58.3%). Treatment was medical in 24 patients (66.7%), requiring re-operation only in 12 cases. The average time of closure of the leak was 35.5 days and the patients were hospitalized a total of 33.7 days on average. Conclusions: In the series studied after resective gastric bypass the leak is presented in 4% of patients. Fever and tachycardia are useful signs to suspect a leak. The early detection of leaks is determinant to reach the best evolution of the patient and success in the treatment.Key words: Leak, complications, morbid obesity, gastric bypass, morbidity. ResumenIntroducción: La obesidad es una enfermedad severa cuya prevalencia continúa en incremento. El bypass gástrico resectivo, es una intervención quirúrgica realizada en nuestro centro, para obesidad; al igual que otras técnicas no está exenta de complicaciones, siendo la filtración una de las más graves. Objetivos: Determinar mediante estudio prospectivo la incidencia, presentación clínica, evolución y tratamiento de pacientes obesos con filtraciones después de bypass gástrico resectivo vía abierta. Material y Método: Desde agosto de 1999 a diciembre de 2009, 900 obesos mórbidos fueron sometidos a bypass gástrico resectivo en Y de Roux vía abierta en el Hospital Clínico de la Universidad de Chile. Se realizó a los pacientes por protocolo, prueba con azul de metileno intraoperatoria y control radiológico con bario postoperatorio. Fue registrada la evolución, exámenes y tratamiento realizado. Resultados: 36 pacientes (4%) desarrollaron filtraciones. De 900Rev.

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Péptido natriurético vascular COR: Característica operativa del receptor CV: Coeficiente de variación CVE: Cardioversión eléctrica DM: Diabetes mellitus DTDVI: Diámetro telediastólico del ventrículo izquierdo DTSVI: Diámetro telesistólico del ventrículo izquierdo E: Especificidad EPOC: Enfermedad pulmonar obstructiva crónica FA: Fibrilación auricular FC: Frecuencia cardíaca FEVI: Fracción de eyección del ventrículo izquierdo FFAA: Fármacos antiarrítmicos