Logan Central

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 evaluating treatments for community-acquired pneumonia CAP, especially in patients admitted to intensive care units ICUs. This trial also adapts to study treatments for respiratory pandemics like COVID-19. The goal is to determine which treatment strategies improve outcomes for patients with severe pneumonia, using a flexible, ongoing approach that can test multiple therapies simultaneously and update as new information becomes available. Participants receive different treatment strategies based on random assignment to study groups. Treatments include various antibiotics, steroids, antivirals, immune modulators, anticoagulation methods, and ventilation strategies. Some treatment options have been closed to recruitment, reflecting the trials adaptive nature. The trial includes several domains targeting specific infections such as influenza and COVID-19, with dosing and duration guided by clinical practice and local guidelines. During the study, participants are monitored closely with assessments including survival up to 90 days, days alive without organ support in ICU, ICU and hospital length of stay, ventilator-free days, organ failure-free days, and quality of life up to 6 months. Researchers collect detailed data on patient outcomes, organ support needs, and hospital discharge status. The study runs until February 2028, with ongoing evaluation to improve pneumonia treatment strategies in ICU settings and during respiratory pandemics.