Cleveland

Kidney failure is a serious and growing health problem that requires treatment with dialysis or transplantation to prevent fatal outcomes. Haemodialysis, the most common treatment in Australia and worldwide, often causes significant burdens such as fatigue, pain, cramps, and a reduced quality of life. The early months of starting haemodialysis are particularly risky, with high mortality rates possibly linked to the sudden loss of remaining kidney function when patients begin the typical three sessions per week treatment. This trial aims to evaluate whether starting haemodialysis incrementally at two sessions per week can maintain quality of life and safety compared to the conventional thrice weekly schedule. Participants in the study will be randomly assigned to receive either incremental haemodialysis starting at two sessions per week or conventional haemodialysis starting at three sessions per week. This international, multicenter randomized trial will recruit 372 adults beginning haemodialysis for kidney failure. The study will compare the two treatment schedules over time to see if the incremental approach preserves patient health and kidney function while reducing treatment burden and costs. During the trial, participants' quality of life will be carefully assessed using kidney disease-specific questionnaires six months after starting dialysis. Researchers will monitor the safety, practicality, and cost-effectiveness of the incremental dialysis method. The study will provide important data on whether this less intensive treatment schedule can benefit patients and families by lowering physical and financial burdens, reducing early mortality, and improving dialysis capacity.

Researchers are establishing the International Registry to Improve Outcomes in Men with Advanced Prostate Cancer (IRONMAN), a study enrolling at least 5,000 men with advanced prostate cancer, including metastatic hormone-sensitive prostate cancer (mHSPC) and metastatic castration-resistant prostate cancer (M0/M1 CRPC). This international cohort will collect data from patients across various countries including Australia, Barbados, Brazil, Canada, and others to better understand differences in care and treatment across academic and community settings worldwide. Participants will receive standard care treatments for metastatic prostate cancer as determined by local practices. The study will collect detailed data at enrollment and during follow-up for a minimum of five years. Blood samples and, when feasible, tumor tissue will be collected at enrollment, at treatment changes, and at one-year follow-up to help identify molecular markers related to treatment response and resistance. During participation, patients will complete patient-reported outcome measures (PROMs) at enrollment and every three months. Physicians will provide questionnaires at enrollment, treatment changes, one-year follow-up, and treatment discontinuation. Researchers will track overall survival, adverse events, comorbidities, treatment changes, and patient quality of life to identify optimal treatment sequences and outcomes for men with advanced prostate cancer.