ANZCTR search results

Dialysis is the process of removing fluid and waste products from the blood of patients who have kidney failure. Most people may be familiar with conventional hemodialysis in specialized kidney wards, for patients who have kidney disease and are otherwise well. It is usually performed for around 4 hours, 3 days per week, however these short periods of high intensity dialysis are often not tolerated by the very sick who are better managed with less intense but continuous dialysis. This continuous type of dialysis is called Continuous Renal Replacement Therapy (CRRT) and it is continued in patients in ICU who have kidney failure, until the patient’s kidneys start to work again or they are well enough to move to intermittent dialysis in a kidney ward. During dialysis, blood from the patient is continuously circulated through a filter in the kidney machine, and waste products are removed. There is always the possibility that the blood may clot as it passes through the filter. Patient stability and carefully controlled fluid removal can be compromised if the kidney machine fails too frequently. The most common reason for failure is blood clotting inside the filter – the more this occurs, the less the patient actually receives treatment, and as each filter costs roughly $400 the treatment becomes increasingly expensive. If blood clotting is prevented inside the filter it can last longer - between 24 and 72 hours. Common methods to stop blood clotting (known as anti-coagulation) include adding heparin or citrate to the circuit in the dialysis machine. The primary aim of this study is to compare the filter life using two methods of anticoagulation in CRRT in the Alfred Intensive Care Unit. The first method involves the use of a blood thinner called heparin. Sometimes when higher doses of heparin are required, another drug called protamine that reverses the blood thinning effect is added to the blood in kidney machine circuit. Adding heparin with or without protamine is the method that is currently most used at the Alfred for CRRT. The second method involves the use of citrate fluid in the kidney machine. The citrate binds with calcium and has an anticoagulant effect. Previously, this method proved more labor intensive for the nurses as additional pumps were needed. It tended to be used in special situations e.g. in patients who were allergic to heparin and/or could not receive blood thinners due to a high risk of bleeding. However, recent improvements in the technology of kidney machines have allowed this method to be used much more simply and efficiently. This study has been designed by our doctors at the Alfred Intensive Care Unit to find out if using citrate in the kidney machine is a better and safer way of using CRRT than using heparin in the kidney machine.

The aim of this study is to determine the effectiveness of a multi-media educational intervention for heart failure patients in reducing unplanned hospital admissions. Associated with this outcome, the study also aims to investigate whether patients who participate in this educational intervention demonstrate improvement in their knowledge and self-care abilities.

The aim of this study is to work towards developing a diagnostic technique to determine patients response to chemotherapy and surgery using circulating tumour (ct) DNA biomarkers. This will reduce the need for excessive chemotherapy treatment therefore reducing the unwanted adverse effects of treatments. Genes are substances in the body which contain information about characteristics about us as indivuals. Previous studies have found that the majority (more than 9 out of 10) of pancreataic cancers contain a mutation in KRAS gene which can be detected in the blood. Identifying biomarkers are important because: they may be linked with disease progression; they may help to identify people who are most likely to benefit from a certain treatment such as chemotherapy and how much treatment they need; and they help to identify people who have partial or complete response to treatment without the need for chemotherapy after surgery

This study will be conducted in healthy individuals to investigate the impact of a co-delivery versus a 3 week course of microencapsulated probiotic (Bifidobacteria) on the degradation and absorption of orange juice flavanones. This will be assessed by: a) Quantitative evaluation of the effective delivery of microencapsulated (MicroMAX Pro (Registered Trademark) – milk protein-sugar-carbohydrate powder) probiotic (Bifido bacteria) by faecal sample examination. b) Analysis of the phenolic acids and flavanone glucuronide and sulphate metabolites in urine and faecal water using high-level analytical techniques (GC-MS and HPLC-MS-MS). This information will provide insights into the impact of a microencapsulated probiotic on the gut microflora, and on the absorption and metabolism of ingested orange juice flavanones. The specific aims of this investigation are: 1. To investigate co-delivery of probiotic with orange juice on the metabolism amnd absorption of flavanones in the large intestine 2. To investigate the impact of a 3 week course of probiotic on the metabolism and absorption of flavanones in the large intestine.

The roles of indoxyl sulphate and p-cresyl sulphate as nephro- and cardiovascular toxins has recently gained recognition, although their true association and mechanisms behind their putative deleterious actions are yet to be investigated in human studies. The aim of this observational study is to gain a better understanding of the associations between these two protein-bound uremic toxins, IS and PCS, and Cardio Vascular Disease (CVD) and CKD progression, along with other poor outcomes seen in CKD. A secondary aim is to determine whether live kidney donors post nephrectomy have an increase concentration of these toxins and any association with morbidity in this population.

Stereotactic body radiotherapy (SBRT) is an new form of cancer treatment involving highly precise radiotherapy. SBRT appears to be effective in controlling cancer in other sites in the body, including the lung and the liver. We aim to test the ability of this new technique to control cancers in the kidney. This is the first step of the research, and is a ‘pilot’ study. Who is it for? You may be eligible to join this study if you are aged greater than 18 years and have a radiological diagnosis or biopsy confirmed diagnosis of either renal cell carcinoma or solitary adrenal metastases. Trial Details If you participate in this study, you will have either a single session of stereotactic body radiotherapy (SBRT) or three sessions of SBRT, depending on how big your cancer is. In order to deliver this treatment, you will need to attend a ‘planning’ session where your body measurements are taken in the position that you will be lying in for your radiotherapy. This visit takes approximately one hour. Once the radiotherapy treatment has been planned, a further ‘mock-up’ visit is required to ensure that the radiotherapy plan can be physically delivered when it comes to the time of treatment. This session will take approximately 45 minutes. When the treatment starts, the total time required to deliver the treatment will be one hour. In addition to the visits required to plan and deliver the radiotherapy, blood samples will be taken as part of this research. These will be taken at the same time as blood is collected to assess your kidney function (which would be standard care). Therefore will not require any additional blood collection visits than would be routinely performed to treat your cancer. Both the kidney function blood sample (standard of care) and the research related blood sample will be taken a total of 3 times; once before treatment, two weeks after treatment, and approximately 70 days to 3 months after treatment. Follow-up will involve a visit at approximately 2.5 to 3 months, and then at 6 months, 9 months, and 12 months from treatment. If you have a primary kidney cancer (renal cell carcinoma), then in addition to the steps outlined above you will have a research related ‘Diffusion weighted-MRI’ scan performed a total of three times; once before treatment, two weeks after treatment, and approximately 70 days to 3 months after treatment. The Diffusion weighted-MRI scan is similar to a standard MRI scan, but is taken over a longer period of time. Each Diffusion weighted-MRI scan takes approximately 30 minutes. For those patients with adequate kidney function, you will also have a contrast injection at the time of the MRI, which will add an additional 10 minutes to the scan time. The MRI allows us to examine the blood flow into kidneys and the cancer. To assess the function of the kidney after the SBRT treatment, a ‘positron emission tomography’ (PET) scan will be taken at approximately the same timepoints as the perfusion scans; once before treatment, two weeks after treatment, and approximately 70 days to 3 months after treatment. This will involve injection of a radioactive tracer and a subsequent scan which will take approximately 30 minutes to capture. This will require you attending the PET Centre for a period of 2 or 3 hours. Participation in this study will involve no extra cost due to either having these scans or the treatment.

Heart surgery is a common procedure, with more than 2500 operations each year in New Zealand. Damage to organs, including kidneys, liver and heart is common after heart surgery and some of the damage may be caused by extra oxygen given on cardiopulmonary bypass. This study will randomise patients to receive normal levels of oxygen or the traditional high levels during heart surgery. Endpoints include a number of blood tests that are very sensitive for detecting damage to the kidney, liver, heart and other organs. In total 286 patients having heart surgery at Auckland City Hospital will be included in this study over a two year period.

The purpose of this pilot study is to is to evaluate and assess a revised enteral nutrition protocol to deliver prescribed volumes of nutritional formula through a cyclic (also known as intermittent) 20-hour continuous method .The current enteral nutrition protocol is based on a 24- hour continuous cycle to deliver prescribed volumes of formula. However, various planned processes and events (such as fasting for endotracheal extubation) often interrupt a 24 hour continuous cycle of feeding potentially resulting in sub-optimal levels of nutrition delivery. Hence, the 20 hour continuous method (with a higher rate of feeding per hour) has been developed so that adequate nutrition can be delivered and planned interruptions can take place within the 4 hour non-feeding “gap” period. a minimum of forty patients will be enrolled from the Monash Medical Centre Intensive Care Unit and will be randomly allocated to a control group ( current 24 hour enteral feeding protocol) or an intervention group (revised 20 hour enteral feeding protocol). Data relating to nutritional and clinical outcomes will be collected for up to 12 days for each participant. The hypotheses is that the new protocol will safely and effectively improve current levels of nutritional adequacy from 48 % (based on local audit) closer to the optimal levels recommended in the literature ( > 80 %) We postulate that this increased provision of calories and protein may translate into improved nutritional and clinical outcomes, but the current study is not powered to demonstrate such a difference.

The purpose of this study is to determine the effect of potassium supplementation in a single meal on blood vessel function. A high potassium intake is associated with reduced risk of heart disease however effect of potassium on blood vessel function is not known. We propose potassium supplementation will improve blood vessel function.

The purpose of this project is to develop a quality of life instrument specific to autoimmune bullous disease. Patients with clinically and histologically diagnose autoimmune bullous disease will be recruited and interviewed regarding the ways their disease affects their quality of life. Based on these responses, a pilot questionnaire will be developed and given to 70 patients. Statistical analysis will then be performed based on the results of these questionnaires to determine whether the instrument is statistically sound or not. If it is validated, the instrument can then be used as a tool to measure quality of life in patients with autoimmune blistering skin diseases.