Enfermedad renal crónica: epidemiología y factores de riesgo / Chronic kidney disease: epidemiology and risk factors

Chile se encuentra en una fase tardía de la transición demográfico epidemiológica, caracterizada por envejecimiento de la población y un enorme aumento de las enfermedades crónicas no transmisibles. Dentro de éstas, se encuentra la enfermedad renal crónica (ERC), y sus factores de riesgo, diabetes e hipertensión. ERC, cuya prevalencia se estima en 10 por ciento, se asocia a un alto riesgo de mortalidad cardiovascular y progresión renal; su evolución es habitualmente silenciosa, y puede pasar inadvertida para los pacientes, médicos y autoridades de salud. Sólo recientemente ha aumentado la conciencia de ERC, como un problema de salud pública, considerando su amplia distribución, complicaciones y costo. Una nueva definición y clasificación de ERC ha contribuido a establecer programas de detección e intervención precoz, que deben hacerse en el nivel de atención primaria. Los gobiernos deben implementar con urgencia programas de tamizaje y vigilancia de ERC, para establecer su magnitud, epidemiología, morbimortalidad y tendencias.

Chile has experienced a demographic and epidemiologic transition, characterized by an age increase in population and an enormous increase of chronic non-communicable diseases. Among these, we can find chronic kidney disease (CKD) and its risk factors, diabetes and hypertension. CKD, whose estimated prevalence is around 10 percent, is associated to a high cardiovascular mortality and renal progression; its clinical course is usually silent, and may be unaware for patients, doctors, health authorities and policy makers. CKD is increasingly recognized as a global public health problem, considering its wide distribution, complications and cost. A new CKD definition and classification has contributed to raise early detection and intervention programs, which must be implemented at the primary health level. Governments should support programs for screening and surveillance of CKD, to document its magnitude, epidemiology, morbimortality, and trends.

Muerte encefálica bioética y trasplante de órganos / Brain death, bioethics and organ transplantation

The concept of death has evolved medically, legally and culturally since the introduction of life support technologies in the middle of the 20th century. The traditional cardiopulmonary and the new neurologically based brain death criterions of death are examined. We conclude that brain death, defined as total and irreversible loss of function of the whole brain, fulfills better "the permanent cessation of functioning of the organism as a whole² definition of death. Brain death diagnosis, based on standard neurologic clinical examination performed accurately, is unequivocal. Transplantation medicine, mostly based on organ donation of brain dead people, has become a routine and universally accepted therapeutic intervention nowadays, which benefits many people. Ethics foundations of organ transplantation are reviewed. Even though brain death and organ donation are widely accepted in medical, legal, religious and public opinion today, the whole society and medical community need to be further educated about these matters, so that unavoidable changes of traditional concepts might be better understood. Permanent education should be the best way to dissipate social fears and distrust towards organ donation and brain death (Rev Méd Chile 2004; 132: 109-18).