Hemodynamic stress during hemodialysis (HD) results in recurrent segmental ischemic injury (myocardial stunning) that drives cumulative cardiac damage. We performed a fully comprehensive study of the cardiovascular effect of dialysis sessions using intradialytic cardiac magnetic resonance imaging (MRI) to examine the comparative acute effects of standard HD versus hemodiafiltration (HDF) in stable patients. We randomly allocated 12 patients on HD (ages 32–72 years old) to either HD or HDF. Patients were stabilized on a modality for 2 weeks before undergoing serial cardiac MRI assessment during dialysis. Patients then crossed over to the other modality and were rescanned after 2 weeks. Cardiac MRI measurements included cardiac index, stroke volume index, global and regional contractile function (myocardial strain), coronary artery flow, and myocardial perfusion. Patients had mean±SEM ultrafiltration rates of 3.8±2.9 ml/kg per hour during HD and 4.4±2.5 ml/kg per hour during HDF (P=0.29), and both modalities provided a similar degree of cooling. All measures of systolic contractile function fell during HD and HDF, with partial recovery after dialysis. All patients experienced some degree of segmental left ventricular dysfunction, with severity proportional to ultrafiltration rate and BP reduction. Myocardial perfusion decreased significantly during HD and HDF. Treatment modality did not influence any of the cardiovascular responses to dialysis. In conclusion, in this randomized, crossover study, there was no significant difference in the cardiovascular response to HDF or HD with cooled dialysate as assessed with intradialytic MRI.

This study demonstrated a considerably high prevalence of NDRD in T2D adults undergoing renal biopsy. The absence of diabetic retinopathy, lower HbA1c values 12 months before biopsy and greater deterioration in HbA1c prior to biopsy predicted NDRD in T2D. Further studies are needed to validate the findings.

BackgroundIntravesical Bacilli Calmette-Guerin (IVBCG) therapy for non-muscle invasive bladder cancer (NMIBC) has long been in use successfully. Albeit rarely, we still face with its safety concerns more than 25 years on since its approval by US Food and Drug Agency in 1990. Local and systemic infection following intravesical BCG is widely reported as compared to immune mediated local or systemic hypersensitivity reactions involving kidneys; acute kidney injury (AKI) and other renal manifestations are well reported but not of chronic kidney disease (CKD).CaseAn interesting case of a female was referred to nephrologists in advanced stages of CKD at an eGFR of 10 ml/min/1.732 following IVBCG for NMIBC. Our patient’s renal function plateaued when IVBCG was held; and worsened again when reinstilled. It introduces the concept of ‘repetitive’ immune mediated renal injury presenting as progressive CKD rather than AKI, as is generally reported. Although response was poor, corticosteroids stopped CKD progression to end stage renal disease.ConclusionsWe highlight the need for increased awareness and early recognition of IVBCG renal complications by both urologists and nephrologists in order to prevent progressive and irreversible renal damage. Low incidence of IVBCG renal complications may also be due to under recognition in the era prior to CKD Staging and AKI Network (and AKI e-alerts) that defined AKI as a rise in serum creatinine of ≥26umol/L; hence an unmet need for urgent prospective studies. Major literature review focuses on emerging spectrum of histopathological IVBCG related renal complications and their outcomes.

A kidney biopsy is an important tool for nephrologists in the diagnosis of renal conditions, but not without the risk of bleeding due to its invasive nature. There is abundance of literature on bleeding complications secondary to this procedure in high-risk patient groups such as amyloidosis and chronic hypertension. An undefined and unrecognized risk is a peritoneal penetration. We report here a case where, despite adequately preparing a patient for a kidney biopsy, distortion of the peritoneum and retroperitoneum from previous surgery resulted in a fatal outcome. This was due to loss of peritoneal integrity and the consequent loss of local anatomical hemostatic mechanism.

The major challenge Project Management Teams (PMT) currently face is the isolated functionality of diverse support disciplines and their tools, leading to delayed and reactive approaches to the project issues. To become more proactive, enhance efficiency, and improve the productivity of current Project Management practices, ADNOC Gas Processing developed a Smart Project Management System (SPMS) that will: Collate and integrate, real-time project data from various software platforms currently in use. Prepare, monitor, and control all project parameters impacting the successful completion of projects. Predictive project analytics by generating automated proactive alerts with recommendations. Provide one unified interface for dashboard, reports, and predictive project management. SPMS is a technology that can add real value and drive positive change in project management and business transformations. SPMS will automate all existing processes and make available all information with drill-down dashboards for Project Planning, Scheduling, Progress Measurement, Safety, Quality, Cost and Budget and lessons learned, Change Orders, Risk Management, Document and Transmittal Management. SPMS also will provide features such as lessons learned to generate alert recommendations, Chat-BOT, and an assistant BOT technology to search the Scope of work, Contract, DGS documents…etc. To achieve our objective, the framework adapted is to include integration, automation, chat-bot, and machine learning attributes in the SPMS software solution. As part of data collection brainstorming, sessions and extensive workshops were conducted with all the project stakeholders such as Consultants, Contractors, PMC, TPI, and PMT in developing a state-of-art project management tool. Desktop reviews and interviews were conducted with product teams to evaluate various solutions such as SAP, ORACLE, ACONEX, ASSAI, WRENCH, and PM-Web as part of the feasibility study and selected a framework to develop a single software platform and to carry out a Pilot study. SPMS was implemented and the validation was carried out on two (2 No's) case study projects. The outcome of the research is that SPMS will support the Project Management team (PMT) to better focus on priority issues and maximize their productivity. A time-consuming activity i.e., Report generation of each project too will be automated with real-time, linked data to reduce man-hours. Furthermore, SPMS will provide the senior management with complete access to real-time project data through I-phones and dashboards. In addition, SPMS gives an early insight of project deviations and issues with help of cognitive intelligent solutions provided by machine learning algorithms hence, proactively enabling a project manager to act timely to deliver a project successfully. This paper covers the overview of existing and enhanced project management practices in the Oil and Gas Industry using SPMS, encountered issues, conclusions drawn and appropriate recommendations.