Integrated global assessment of the natural forest carbon potential.

Forests are a substantial terrestrial carbon sink, but anthropogenic changes in land use and climate have considerably reduced the scale of this system1. Remote-sensing estimates to quantify carbon losses from global forests2-5 are characterized by considerable uncertainty and we lack a comprehensive ground-sourced evaluation to benchmark these estimates. Here we combine several ground-sourced6 and satellite-derived approaches2,7,8 to evaluate the scale of the global forest carbon potential outside agricultural and urban lands. Despite regional variation, the predictions demonstrated remarkable consistency at a global scale, with only a 12% difference between the ground-sourced and satellite-derived estimates. At present, global forest carbon storage is markedly under the natural potential, with a total deficit of 226 Gt (model range = 151-363 Gt) in areas with low human footprint. Most (61%, 139 Gt C) of this potential is in areas with existing forests, in which ecosystem protection can allow forests to recover to maturity. The remaining 39% (87 Gt C) of potential lies in regions in which forests have been removed or fragmented. Although forests cannot be a substitute for emissions reductions, our results support the idea2,3,9 that the conservation, restoration and sustainable management of diverse forests offer valuable contributions to meeting global climate and biodiversity targets.

The number of tree species on Earth.

One of the most fundamental questions in ecology is how many species inhabit the Earth. However, due to massive logistical and financial challenges and taxonomic difficulties connected to the species concept definition, the global numbers of species, including those of important and well-studied life forms such as trees, still remain largely unknown. Here, based on global ground-sourced data, we estimate the total tree species richness at global, continental, and biome levels. Our results indicate that there are ∼73,000 tree species globally, among which ∼9,000 tree species are yet to be discovered. Roughly 40% of undiscovered tree species are in South America. Moreover, almost one-third of all tree species to be discovered may be rare, with very low populations and limited spatial distribution (likely in remote tropical lowlands and mountains). These findings highlight the vulnerability of global forest biodiversity to anthropogenic changes in land use and climate, which disproportionately threaten rare species and thus, global tree richness.

[Consensus document for the detection and management of chronic kidney disease]. / Documento de consenso para la detección y manejo de la enfermedad renal crónica.

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations.

Uncertainty in REDD+ carbon accounting: a survey of experts involved in REDD+ reporting.

BACKGROUND: Reducing Emissions from Deforestation and forest Degradation (REDD+) is a program established under the United Nations Framework Convention on Climate Change (UNFCCC) to reduce carbon emissions from forests in developing countries. REDD+ uses an incentive-based approach whereby participating countries are paid to reduce forest carbon loss and increase carbon storage. Country-level carbon accounting is challenging, and estimates of uncertainty in emission reductions are increasingly required in REDD+ reports. This requirement is hard to meet if countries lack the necessary resources, tools, and capabilities. Some REDD+ programs adjust their payments for the uncertainty reported, which presents a perverse incentive because uncertainties are larger if more sources of uncertainty are reported. We surveyed people involved in REDD+ reporting to assess current capacities and barriers to improving estimates of uncertainty. RESULTS: Representatives from 27 countries (44% of REDD+ countries at the time of survey implementation) responded to the survey. Nearly all respondents thought it important to include uncertainty in REDD+ reports, but most felt that the uncertainty reporting by their countries was inadequate. Our independent assessment of reports by these countries to the UNFCCC supported this opinion: Most countries reported uncertainty in activity data (91%) but not in emission factors (4-14%). Few countries use more advanced approaches to estimate uncertainty, such as Monte Carlo and Bayesian techniques, and many respondents indicated that they lack expertise, knowledge, or technical assistance. Other barriers include lack of financial resources and appropriate data. Despite these limitations, nearly all respondents indicated a strong desire to improve estimates of uncertainty in REDD+ reports. CONCLUSIONS: The survey indicated that people involved in REDD+ reporting think it highly important to improve estimates of uncertainty in forest carbon accounting. To meet this challenge, it is essential to understand the obstacles countries face in quantifying uncertainty so we can identify where best to allocate efforts and funds. Investments in training and resources are clearly needed to better quantify uncertainty and would likely have successful outcomes given the strong desire for improvement. Tracking the efficacy of programs implemented to improve estimates of uncertainty would be useful for making further refinements.

Spatial database of planted forests in East Asia.

Planted forests are critical to climate change mitigation and constitute a major supplier of timber/non-timber products and other ecosystem services. Globally, approximately 36% of planted forest area is located in East Asia. However, reliable records of the geographic distribution and tree species composition of these planted forests remain very limited. Here, based on extensive in situ and remote sensing data, as well as an ensemble modeling approach, we present the first spatial database of planted forests for East Asia, which consists of maps of the geographic distribution of planted forests and associated dominant tree genera. Of the predicted planted forest areas in East Asia (948,863 km2), China contributed 87%, most of which is located in the lowland tropical/subtropical regions, and Sichuan Basin. With 95% accuracy and an F1 score of 0.77, our spatially-continuous maps of planted forests enable accurate quantification of the role of planted forests in climate change mitigation. Our findings inform effective decision-making in forest conservation, management, and global restoration projects.

Exploring characteristics of national forest inventories for integration with global space-based forest biomass data.

National forest inventories (NFIs) are a reliable source for national forest measurements. However, they are usually not developed for linking with remotely sensed (RS) biomass information. There are increasing needs and opportunities to facilitate this link towards better global and national biomass estimation. Thus, it is important to study and understand NFI characteristics relating to their integration with space-based products; in particular for the tropics where NFIs are quite recent, less frequent, and partially incomplete in several countries. Here, we (1) assessed NFIs in terms of their availability, temporal distribution, and extent in 236 countries from FAO's Global Forest Resources Assessment (FRA) 2020; (2) compared national forest biomass estimates in 2018 from FRA and global space-based Climate Change Initiative (CCI) product in 182 countries considering NFI availability and temporality; and (3) analyzed the latest NFI design characteristics in 46 tropical countries relating to their integration with space-based biomass datasets. We observed significant NFI availability globally and multiple NFIs were mostly found in temperate and boreal countries while most of the single NFI countries (94 %) were in the tropics. The latest NFIs were more recent in the tropics and many countries (35) implemented NFIs from 2016 onwards. The increasing availability and update of NFIs create new opportunities for integration with space-based data at the national level. This is supported by the agreement we found between country biomass estimates for 2018 from FRA and CCI product, with a significantly higher correlation in countries with recent NFIs. We observed that NFI designs varied greatly in tropical countries. For example, the size of the plots ranged from 0.01 to 1 ha and more than three-quarters of the countries had smaller plots of ≤0.25 ha. The existing NFI designs could pose specific challenges for statistical integration with RS data in the tropics. Future NFI and space-based efforts should aim towards a more integrated approach taking advantage of both data streams to improve national estimates and help future data harmonization efforts. Regular NFI efforts can be expanded with the inclusion of some super-site plots to enhance data integration with currently available space-based applications. Issues related to cost implications versus improvements in the accuracy, timeliness, and sustainability of national forest biomass estimation should be further explored.

Co-limitation towards lower latitudes shapes global forest diversity gradients.

The latitudinal diversity gradient (LDG) is one of the most recognized global patterns of species richness exhibited across a wide range of taxa. Numerous hypotheses have been proposed in the past two centuries to explain LDG, but rigorous tests of the drivers of LDGs have been limited by a lack of high-quality global species richness data. Here we produce a high-resolution (0.025° × 0.025°) map of local tree species richness using a global forest inventory database with individual tree information and local biophysical characteristics from ~1.3 million sample plots. We then quantify drivers of local tree species richness patterns across latitudes. Generally, annual mean temperature was a dominant predictor of tree species richness, which is most consistent with the metabolic theory of biodiversity (MTB). However, MTB underestimated LDG in the tropics, where high species richness was also moderated by topographic, soil and anthropogenic factors operating at local scales. Given that local landscape variables operate synergistically with bioclimatic factors in shaping the global LDG pattern, we suggest that MTB be extended to account for co-limitation by subordinate drivers.

[Management of patients with dyslipidaemia in Spain. The Cardio Right Care Control of cardiovascular risk project]. / Manejo del paciente con dislipidemia en España. Proyecto Cardio Right Care Control del Riesgo Cardiovascular.

OBJECTIVE: To ascertain the opinion of physicians about diagnostic criteria, control targets, control rates, and therapeutic approach of patients with dyslipidaemia in Spain. METHODS: A specific questionnaire was created about diagnostic criteria, control targets, control rates, lipid lowering therapies, and therapeutic inertia in patients with dyslipidaemia. Physicians completed the questionnaire online during a 4-month period. RESULTS: A total of 959 questionnaires were collected from all over Spain. The most frequent scale to stratify cardiovascular risk is SCORE (54.9%), and guidelines from the European Society of Cardiology are the most common guidelines used (50.5%). The majority of patients are on primary prevention (57.7%), and 31.4% have a high-very high cardiovascular risk. More than 70% of investigators considered that the target among patients at very high risk and those in secondary prevention is an LDL cholesterol < 70 mg/dL. It is considered by 60.0% and 66.4% of investigators that their patients on primary and secondary prevention, respectively, achieve control targets. Statins are the most common lipid lowering drugs used, followed by ezetimibe. In the majority of cases, when a patient is not adequately controlled with statins, there is an increase in the dose or a change to another statin. Poor adherence to treatment and therapeutic inertia are the main reasons for poor LDL cholesterol control. CONCLUSIONS: The Cardio Right Care CVR Control project allows those aspects to be identified, as well as areas of improvement in patients with dyslipidaemia in Spain.

Emerging threats linking tropical deforestation and the COVID-19 pandemic.

Tropical deforestation drivers are complex and can change rapidly in periods of profound societal transformation, such as those during a pandemic. Evidence suggests that the COVID-19 pandemic has spurred illegal, opportunistic forest clearing in tropical countries, threatening forest ecosystems and their resident human communities. A total of 9583 km2 of deforestation alerts from Global Land Analysis & Discovery (GLAD) were detected across the global tropics during the first month following the implementation of confinement measures of local governments to reduce COVID-19 spread, which is nearly double that of 2019 (4732 km2). We present a conceptual framework linking tropical deforestation and the current pandemic. Zoonotic diseases, public health, economy, agriculture, and forests may all be reciprocally linked in complex positive and negative feedback loops with overarching consequences. We highlight the emerging threats to nature and society resulting from this complex reciprocal interplay and possible policy interventions that could minimize these threats.

Metapopulations in multifractal landscapes: on the role of spatial aggregation.

The use of fractals in ecology is currently pervasive over many areas. However, very few studies have linked fractal properties of landscapes to generating ecological mechanisms and dynamics. In this study I show that lacunarity (a measure of the landscape texture) is a well suited ecologically scaled landscape index that can be explicitly incorporated in metapopulation models such as the classical Levins equation. I show that the average lacunarity of an aggregated landscape is linearly correlated to the habitat that a species with local spatial processed information may perceive. Lacunarity is a computationally feasible index to measure, and is related to the metapopulation capacity of landscapes. A general approach to multifractal landscapes has been conceived, and some analytical results for self-similar landscapes are outlined, including the specific effect of landscape heterogeneity, decoupled from that of contagion by dispersal. Spatially explicit simulations show agreement with the semi-implicit method presented.

Environmental Risk Assessment (ERA) of diclofenac and ibuprofen: a public health perspective.

Non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used in human and veterinary medicine, representing potential aquatic environmental contamination. This study aimed to perform an Environmental Risk Assessment (ERA) of NSAIDs diclofenac (Dic) and ibuprofen (Ibu) in cities of the state of Paraná, Brazil, over the course of three years, by using available data from the Brazilian Public Health System. The environmental risk (ER) was assessed by employing the European Medicines Agency (EMeA) approach, and predicted environmental concentrations (PECs) were calculated. The refined PECs considered the drug metabolism and the excretion data, and also the sewage treatment plant removal rates of biological filters and activated sludge processes to define environmental scenarios. References to the predicted no effect concentration (PNEC) for these pharmaceuticals were considered, and the PEC/PNEC ratio was calculated; ratio values ⩾ 1 suggested an ER. Environmental risk was conducted on several cities, and the lack of an adequate sanitation system in the majority of Paraná cities forecasts a significant concern with the exposure to possible environmental damages in those cities. The high PEC/PNEC ratios in several cities showed that current usage patterns of these drugs constitute an environmental issue in need of resolution by health and environmental authorities.

Modelling remediation scenarios in historical mining catchments.

Local remediation measures, particularly those undertaken in historical mining areas, can often be ineffective or even deleterious because erosion and sedimentation processes operate at spatial scales beyond those typically used in point-source remediation. Based on realistic simulations of a hybrid landscape evolution model combined with stochastic rainfall generation, we demonstrate that similar remediation strategies may result in differing effects across three contrasting European catchments depending on their topographic and hydrologic regimes. Based on these results, we propose a conceptual model of catchment-scale remediation effectiveness based on three basic catchment characteristics: the degree of contaminant source coupling, the ratio of contaminated to non-contaminated sediment delivery, and the frequency of sediment transport events.

[Consensus document for the detection and management of chronic kidney disease]. / Documento de consenso para la detección y manejo de la enfermedad renal crónica.

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations.

[Consensus document for the detection and management of chronic kidney disease]. / Documento de consenso para la detección y manejo de la enfermedad renal crónica.

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations.

Consensus document for the detection and management of chronic kidney disease.

Chronic kidney disease (CKD) is a major public health problem that, in its different stages, may affect up to 10% of the Spanish population and results in high morbidity and mortality, as well as high consumption of National Health System resources. Ten scientific societies involved in the management of kidney patients agreed to update the 2007 CKD consensus document. The current version is an abridged edition of the detailed general document, which can be consulted on the webpages of each signatory society. It includes the following aspects: CKD definition, epidemiology and risk factors and criteria on diagnosis, assessment and staging of CKD, albuminuria and glomerular filtration estimation. Progression factors and concept. Criteria for referral to Nephrology. Patient follow-up, attitudes and objectives by specialty. Prevention of nephrotoxicity. Detection of cardiovascular damage. Attitudes, lifestyle and treatment: management of high blood pressure, dyslipidaemia, hyperglycaemia, smoking, obesity, hyperuricaemia, anaemia and mineral and bone metabolism disorders. Coordinated follow-up by Primary Care – other specialties – Nephrology. Management of renal replacement therapy, haemodialysis, peritoneal dialysis and renal transplantation patients. Palliative treatment of terminal uraemia. We hope that this document will be very useful in the multidisciplinary management of CKD patients, in view of the updated recommendations.

Habitat hydrology and geomorphology control the distribution of malaria vector larvae in rural Africa.

BACKGROUND: Larval source management is a promising component of integrated malaria control and elimination. This requires development of a framework to target productive locations through process-based understanding of habitat hydrology and geomorphology. METHODS: We conducted the first catchment scale study of fine resolution spatial and temporal variation in Anopheles habitat and productivity in relation to rainfall, hydrology and geomorphology for a high malaria transmission area of Tanzania. RESULTS: Monthly aggregates of rainfall, river stage and water table were not significantly related to the abundance of vector larvae. However, these metrics showed strong explanatory power to predict mosquito larval abundances after stratification by water body type, with a clear seasonal trend for each, defined on the basis of its geomorphological setting and origin. CONCLUSION: Hydrological and geomorphological processes governing the availability and productivity of Anopheles breeding habitat need to be understood at the local scale for which larval source management is implemented in order to effectively target larval source interventions. Mapping and monitoring these processes is a well-established practice providing a tractable way forward for developing important malaria management tools.

Asociación de obesidad general y abdominal con hipertensión, dislipemia y presencia de prediabetes en el estudio PREDAPS / Association of general and abdominal obesity with hypertension, dyslipidemia and prediabetes in the PREDAPS study

Introducción y objetivos: Algunas medidas antropométricas muestran mayor capacidad que otras para discriminar la presencia de factores de riesgo cardiovascular. Este trabajo estima la magnitud de la asociación de diversos indicadores antropométricos de obesidad con hipertensión, dislipemia y prediabetes (glucemia basal o glucohemoglobina alteradas). Métodos: Análisis transversal de la información recogida en 2.022 sujetos del estudio PREDAPS (etapa basal). Se definió obesidad general como índice de masa corporal ≥ 30 kg/m2 y obesidad abdominal con 2 criterios: a) perímetro de cintura (PC) ≥ 102 cm en varones/PC ≥ 88 cm en mujeres, y b) índice cintura/estatura (ICE) ≥ 0,55. La magnitud de la asociación se estimó mediante regresión logística. Resultados: La hipertensión arterial mostró la asociación más alta con la obesidad general en mujeres (OR = 3,01; IC95%, 2,24-4,04) y con la obesidad abdominal según el criterio del ICE en varones (OR = 3,65; IC95%, 2,66-5,01). La hipertrigliceridemia y los valores bajos de colesterol unido a lipoproteínas de alta densidad mostraron la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,49; IC95%, 1,68-3,67 y OR = 2,70; IC95%, 1,89-3,86) y la obesidad general en varones (OR = 2,06; IC95%, 1,56-2,73 y OR = 1,68; IC95%, 1,21-2,33). La prediabetes mostró la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,48; IC95%, 1,85-3,33) y con obesidad abdominal según el criterio del PC en varones (OR = 2,33; IC95%, 1,75-3,08). Conclusiones: Los indicadores de obesidad abdominal mostraron la mayor asociación con la presencia de prediabetes. La relación de los indicadores antropométricos con hipertensión y con dislipemia mostró resultados heterogéneos (AU)

Introduction and objectives: Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin). Methods: Cross-sectional analysis of information collected from 2022 participants in the PREDAPS study (baseline phase). General obesity was defined as body mass index ≥ 30 kg/m2 and abdominal obesity was defined with 2 criteria: a) waist circumference (WC) ≥ 102 cm in men/WC ≥ 88 cm in women, and b) waist-height ratio (WHtR) ≥ 0.55. The magnitude of the association was estimated by logistic regression. Results: Hypertension showed the strongest association with general obesity in women (OR, 3.01; 95%CI, 2.24-4.04) and with abdominal obesity based on the WHtR criterion in men (OR, 3.65; 95%CI, 2.66-5.01). Hypertriglyceridemia and low levels of high-density lipoprotein cholesterol showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.49; 95%CI, 1.68-3.67 and OR, 2.70; 95%CI, 1.89-3.86) and with general obesity in men (OR, 2.06; 95%CI, 1.56-2.73 and OR, 1.68; 95%CI, 1.21-2.33). Prediabetes showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.48; 95%CI, 1.85-3.33) and with abdominal obesity based on the WC criterion in men (OR, 2.33; 95%CI, 1.75-3.08). Conclusions: Abdominal obesity indicators showed the strongest association with the presence of prediabetes. The association of anthropometric indicators with hypertension and dyslipidemia showed heterogeneous results (AU)

Documento de consenso para la detección y manejo de la enfermedad renal crónica / Consensus document for the detection and management of chronic kidney disease

La enfermedad renal crónica (ERC) es un importante problema de salud pública que puede afectar en sus diferentes estadios a cerca del 10 % de la población española y que supone una elevada morbilidad y mortalidad, así como un importante consumo de recursos al Sistema Nacional de Salud. Diez sociedades científicas involucradas en el manejo del paciente renal nos hemos puesto de acuerdo para hacer una puesta al día del anterior documento de consenso sobre ERC de 2007. El presente es la edición abreviada del documento general extenso, que puede ser consultado en las páginas web de cada una de las sociedades firmantes. Contiene los siguientes aspectos: definición, epidemiología y factores de riesgo de la ERC. Criterios de diagnóstico, evaluación y estadiaje de la ERC, albuminuria y estimación del filtrado glomerular. Concepto y factores de progresión. Criterios de derivación a Nefrología. Seguimiento del paciente, actitudes y objetivos por especialidad. Prevención de la nefrotoxicidad. Detección del daño cardiovascular. Actitudes, estilo de vida y tratamiento: manejo de la hipertensión arterial, dislipemia, hiperglucemia, tabaquismo, obesidad, hiperuricemia, anemia, alteraciones del metabolismo mineral y óseo. Seguimiento coordinado por Atención Primaria-otras especialidades-Nefrología. Manejo del paciente en tratamiento renal sustitutivo, hemodiálisis, diálisis peritoneal y trasplante renal. Tratamiento paliativo de la uremia terminal. Esperamos que sirva de gran ayuda en el manejo multidisciplinar del paciente con ERC, a la vista de las recomendaciones más actualizadas (AU)

Chronic kidney disease (CKD) is a major public health problem that, in its different stages, may affect up to 10% of the Spanish population and results in high morbidity and mortality, as well as high consumption of National Health System resources. Ten scientific societies involved in the management of kidney patients agreed to update the 2007 CKD consensus document. The current version is an abridged edition of the detailed general document, which can be consulted on the webpages of each signatory society. It includes the following aspects: CKD definition, epidemiology and risk factors and criteria on diagnosis, assessment and staging of CKD, albuminuria and glomerular filtration estimation. Progression factors and concept. Criteria for referral to Nephrology. Patient follow-up, attitudes and objectives by specialty. Prevention of nephrotoxicity. Detection of cardiovascular damage. Attitudes, lifestyle and treatment: management of high blood pressure, dyslipidaemia, hyperglycaemia, smoking, obesity, hyperuricaemia, anaemia and mineral and bone metabolism disorders. Coordinated follow-up by Primary Care - other specialties - Nephrology. Management of renal replacement therapy, haemodialysis, peritoneal dialysis and renal transplantation patients. Palliative treatment of terminal uraemia. We hope that this document will be very useful in the multidisciplinary management of CKD patients, in view of the updated recommendations (AU)

Documento de consenso para la detección y manejo de la enfermedad renal crónica / Consensus document for the detection and management of chronic kidney disease

La enfermedad renal crónica (ERC) es un importante problema de salud pública que puede afectar en sus diferentes estadios a cerca del 10% de la población española y que supone una elevada morbimortalidad, así como un importante consumo de recursos al Sistema Nacional de Salud. Diez sociedades científicas involucradas en el manejo del paciente renal nos hemos puesto de acuerdo para hacer una puesta al día del anterior documento de consenso sobre ERC de 2007. El presente es la edición abreviada del documento general extenso, que puede ser consultado en las páginas Web de cada una de las sociedades firmantes. Contiene los siguientes aspectos: definición, epidemiología y factores de riesgo de la ERC; criterios de diagnóstico, evaluación y estadificación de la ERC, albuminuria y estimación del filtrado glomerular; concepto y factores de progresión; criterios de derivación a nefrología; seguimiento del paciente, actitudes y objetivos por especialidad; prevención de la nefrotoxicidad; detección del daño cardiovascular; actitudes, estilo de vida y tratamiento: manejo de la hipertensión arterial, dislipidemia, hiperglucemia, tabaquismo, obesidad, hiperuricemia, anemia, alteraciones del metabolismo mineral y óseo; seguimiento coordinado por atención primaria-otras especialidades-nefrología; manejo del paciente en tratamiento renal sustitutivo, hemodiálisis, diálisis peritoneal y trasplante renal; tratamiento paliativo de la uremia terminal. Esperamos que sirva de gran ayuda en el manejo multidisciplinar del paciente con ERC, a la vista de las recomendaciones más actualizadas

Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations