Logan Central

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 evaluating a range of treatments to improve outcomes for adults admitted to intensive care units (ICUs) with severe community-acquired pneumonia (CAP), including cases caused by influenza and COVID-19. This Phase 3 adaptive platform trial, REMAP-CAP, is designed to test multiple treatment strategies simultaneously and adapt over time, allowing new treatments to be added as questions are answered. The trial also serves as a platform to quickly evaluate treatments during respiratory pandemics, such as COVID-19, through a sub-study called REMAP-COVID in the United States. Participants receive various interventions including antibiotics like ceftriaxone, moxifloxacin, or piperacillin-tazobactam, as well as macrolide therapies given for different durations. Other treatments assessed include corticosteroids such as hydrocortisone and dexamethasone, antiviral agents like oseltamivir and remdesivir, immune modulators including tocilizumab and baricitinib, and supportive care strategies such as mechanical ventilation methods. Dosing and duration vary for each treatment, with some interventions now closed. Treatments are administered according to local guidelines and clinical decisions, with some requiring intravenous or enteral routes. Participants are closely monitored with assessments focusing on survival and organ support status in the ICU up to 90 days after enrollment. The main outcomes measured include all-cause mortality by day 90 and the number of days alive without needing organ support in the ICU by day 21. The study collects data continuously to adapt treatment assignments for new participants, aiming to identify the most effective therapies. Follow-up and safety monitoring continue throughout hospitalization and up to 90 days after admission.