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In December 2019, cases of acute respiratory illness of unknown origin were reported in Wuhan, China. The disease is caused by “severe acute respiratory syndrome coronavirus 2”. After identifying severe lung damage, injury to other organs, such as the kidney, has been identified. Peritoneal dialysis is a renal replacement therapy (RRT) and is at least as effective as other extracorporeal therapy options, with significant cost-effective advantages. However, this strategy is rarely used for the management of acute kidney injury in severe lung disease. In this review, we explore PD as an RRT strategy that may be a key instrument in countries and hospitals with limited access to all RRTs.

Intradialytic hypotension occurs in 10&ndash, 30% of hemodialysis (HD) sessions. This phenomenon affects the cardiovascular system&rsquo, s functions, which are reflected in the activity of the autonomic nervous system (ANS). To indirectly assess the ANS during HD, we analyzed the mean R&ndash, R intervals and the spectral power of heart rate variability (HRV) from 20 end-stage renal disease patients divided into hypotensive and non-hypotensive groups. The spectrotemporal analysis was accomplished using short-time Fourier transform with 10 min epochs of HRV overlapping by 40%. The spectral power was divided into three segments according to high frequency, low frequency, and very low frequency bandwidths and averaged to fit quadratic regression models. The analysis of the mean R&ndash, R intervals showed significant differences between the groups (p = 0.029). The power variation over time was significant in each spectral band (p ≪ 0.05). The average power, maximum power, and time when the peak was reached differed for each band and between groups, showing the ability to correctly identify the decompensation of the ANS and discriminate between hypotensive and non-hypotensive patients. Additionally, the changes in the sympathovagal ratio were not significant and very scattered for the hypotensive group (p = 0.23) compared to the non-hypotensive group, where the changes were significant (p ≪ 0.05) and much less scattered.

Heart rate variability (HRV) has been used to indirectly assess and study the autonomic nervous system (ANS). For the analysis of HRV, two different time windows are recommended.

Introduction: Patients in hemodiafiltration (HDF) eliminate volume overload by ultrafiltration. Vascular volume loss is among the main mechanisms contributing to adverse events such as intradialytic hypotension. Here, we hypothesize that the intradialytic exercise (IDEX) is an intervention that could improve the acute response of physiological mechanisms involved during vascular volume loss. To test this hypothesis, we evaluated the hemodynamic response to mild aerobic exercise during HDF. Methods: Nineteen end-stage renal disease (ESRD) patients (11 women: 40 ± 10.8 years old, and 8 men: 42 ± 21 years old) receiving HDF thrice a week, with 6 months of previous physical conditioning, participated in this study. Three HDF sessions were scheduled for each patient: 1 resting in supine position, 1 resting in sitting position, and 1 doing aerobic exercise. The first 2 sessions were taken as control. The ultrafiltration rate was set to 800 mL/h in each session. The hemodynamic response was monitored through the relative blood volume (RBV), and cardiovascular variables measured noninvasively by photoplethysmography. Adequacy variables such as Kt/V and percentage reduction of urate, urea, creatinine (Cr), and phosphate were also monitored. Findings: The decrease rate of the RBV was smaller in the session with IDEX compared to the sessions with no exercise. No differences were found neither in the cardiovascular variables nor in the adequacy variables among the 3 sessions. There were no hypotension events during the session with exercise, and 8 events during the sessions without exercise (p = 0.002). Discussion: Mild exercise during HDF decreased the RBV drop and was associated with less hypotension events. The lack of differences in the hemodynamic variables suggests an adequate acute response of cardiovascular compensation variables to intradialytic hypovolemia.

Power spectral analysis of heart rate variability (HRV) offers a possibility to non-invasively quantify autonomic cardiac regulation. The technique splits the spectrum of the HRV into high frequency (HF), low frequency (LF) and very-low frequency (VLF) bands, and relates their power content to parasympathetic outflow, sympathetic outflow, and hormonal factors as well as thermoregulation, respectively. In this work, we applied this technique on HRV data from 20 end-stage renal disease (ESRD) patients to estimate power distribution in these three bands as well as their changes respect to time during hemodiafiltration (HDF) therapy; as an indirect way to assess the modulatory activity over the cardiac system. HRV data was processed using the continuous wavelet transform (CWT), power was estimated using 5-min as well as 10-min epochs for comparison purposes, and the results were normalized to unity before linear regression analysis. For 5-min epochs, the LF power increased (p = 0.035), while there were no significant changes in the HF power (p = 0.2). In contrast, for 10-min epochs, both the LF (p = 0.002) and HF (p = 0.043) power decreased, while the VLF power increased (p