Cleveland

Kidney failure is a serious health problem that requires treatment with dialysis or transplantation to survive. Haemodialysis, the most common treatment, can cause symptoms like fatigue, pain, cramps, and poor quality of life, with less than 60% of full health reported by patients. Early mortality rates are high, especially in the first 3 to 6 months after starting haemodialysis at the usual three sessions per week. This trial investigates whether starting haemodialysis incrementally at two sessions per week preserves quality of life and kidney function better than conventional treatment. The study compares two approaches incremental haemodialysis, where participants begin with two sessions per week and increase to three sessions only if needed, and conventional haemodialysis, where participants start with three sessions per week from the beginning. This randomized, open-label trial will recruit 372 participants across centers in Australia and Canada. The goal is to assess if the incremental method is a safe, practical, and cost-effective alternative that reduces the physical and financial burdens of dialysis. Participants will be followed for up to 18 months, with quality of life assessed at 6 months using the Kidney Disease Quality of Life Short Form questionnaire as the primary measure. Additional assessments include kidney function, healthcare use and costs, mortality, hospital admissions, symptoms, fatigue, nutritional status, and vascular access, collected at regular intervals. The study will monitor safety and side effects throughout the trial period to provide comprehensive data on the impacts of both dialysis approaches.

Researchers are establishing the International Registry to Improve Outcomes in Men with Advanced Prostate Cancer IRONMAN as a prospective, global group of at least 5,000 men with advanced prostate cancer, including those with metastatic hormone-sensitive prostate cancer mHSPC and metastatic castration-resistant prostate cancer M0M1 CRPC. This study aims to better understand variations in care and treatment across different countries and medical settings by collecting detailed patient data over time. Participants will receive standard care drugs routinely used for metastatic prostate cancer based on local practices. Data collection begins at enrollment and continues for at least five years. Blood samples and tumor tissue, when possible, will be collected at enrollment, treatment changes, and follow-ups to study molecular markers linked to treatment response and resistance. Patient-reported outcome measures PROMs will be gathered every three months, and physicians will provide treatment and follow-up information regularly. During the study, participants will provide health and treatment information through questionnaires, with regular monitoring of survival, adverse events, and comorbidities. Blood samples will support future research to identify biomarkers. The main outcome is observing practice patterns over five years to help improve understanding of treatment sequences that optimize survival and quality of life for men with advanced prostate cancer.