Kingston

Researchers are evaluating the effects of two different default dialysate sodium concentrations, 137 mmol/l and 140 mmol/l, on major cardiovascular events and death in adults receiving maintenance haemodialysis. This pragmatic, cluster-randomised, open-label study takes place in real-world dialysis sites and aims to compare the outcomes associated with these sodium levels over an extended period. The study focuses on patients with end-stage kidney disease undergoing regular haemodialysis treatment. Dialysis sites are randomly assigned to use either a default dialysate sodium concentration of 137 mmol/l or 140 mmol/l for at least 90% of dialysis sessions at that site. All other care practices continue as usual based on local standards. The study plans to recruit sites over 5 to 7 years, with individual follow-up lasting roughly 2 to 5 years. Site participation requires consent, while individual patient consent may be waived or offered an opt-out option. Participants will be monitored for major cardiovascular events and death, with the primary outcome measuring the time until the first such event occurs. Data collection methods are implemented across participating dialysis units, focusing only on in-center or satellite dialysis patients where applicable. The study's duration depends on the occurrence of endpoints, with an average follow-up of about 5 years anticipated per participant.

Researchers are evaluating diagnostic methods at Rapid Diagnostic Centres (RDCs) in England to improve cancer detection in patients presenting with common but unclear symptoms such as weight loss, fatigue, cough, or general practitioner suspicion. These centres aim to provide faster and more personalized cancer diagnosis, especially for patients with non-specific symptoms that are often harder to interpret. The study focuses on developing new blood or non-blood tests to identify which patients have cancer and which are at higher risk for future cancer, enhancing current diagnostic pathways. The study will collect breath, blood, and saliva samples from approximately 1000 patients attending RDCs. Breath samples will be collected from around 300 patients, while blood and saliva samples will be collected from about 1000 patients. Samples will be taken at the first appointment and potentially at up to three follow-up visits if needed. The study will use these samples alongside routine clinical data, imaging scans for some patients, and patient questionnaires to develop tests that can distinguish cancer from non-cancer cases and identify cancer types. Each participant will be assigned a unique Study ID to protect their personal information. Participants will provide clinical data, biological samples, and health questionnaires at multiple appointments. Researchers will analyze the accuracy of clinical data review, polygenic risk scores, imaging radiomics, and multiparametric machine learning analyses over a 5-year period. Patients will be followed for 12 months after recruitment to confirm diagnoses or monitor stability. The study aims to develop tests that can correctly classify patients and support earlier cancer detection while protecting patient privacy and maintaining confidentiality throughout the study.