Randomized Trial of Dietary Nitrate Supplementation in CKD Pregnancy (ORCHARD-BEET)

作者：P. N. Smith, Danielle Ashworth, Rachel Hung, Yanzhong Wang, Andrew J. Webb, Kathryn Dalrymple, Katherine Clark, Lucy C. Chappell, Kate Wiles, Kate Bramham, P. N. Smith, Kate Bramham, Kate Wiles, Matthew Hall, Liz Lightstone, Philip Webster, Jenny Myers, Lucy Chappell, Laura McCabe, Jennifer Sparkes, Jorge Jesus-Silva, Alison Armitage, Laura Skinner, K. Bramham, P. Smith, L. C. Chappell, D. Ashworth, K. Clark, K. Dalrymple, A. Clery, C. Reid, L. MacKillop, E. Cottrell, D. Banerjee, F. McCarthy, M. Dodd, E. Wong · 发表于：Kidney International Reports · 年份：2026 · DOI：10.1016/j.ekir.2026.106704 · 研究领域：Pregnancy and preeclampsia studies、Pregnancy and Medication Impact、Gestational Diabetes Research and Management

Introduction Nearly half of pregnant women with moderate-severe chronic kidney disease (CKD) will require dialysis or lose ≥25% kidney function by 12-months after delivery with high rates of neonatal complications. No targeted approaches have been developed to improve maternal outcomes. Methods Pregnant women with stage G2-G5 CKD (<25 weeks' gestation) at eight centres in United Kingdom were randomised to standard care or daily beetroot juice (dietary nitrate 400mg) within an observational cohort. Exclusions were established dialysis, <18 years, major congenital fetal abnormality, multifetal pregnancy and beetroot allergy. Primary outcome was recruitment rate per site per month. Secondary outcomes included feasibility measures as well as maternal and fetal/neonatal clinical and safety events. Results 108 participants were randomised (54/arm); overall mean recruitment rate was 1.01/site/month (SD 0.90). Women receiving dietary nitrate with pre-pregnancy eGFR<45ml/min/1.73m 2 tended to have lower median creatinine concentrations post-partum compared to standard care (6-week: Cr 176μmol/L (IQR 165,194) v 226μmol/L (IQR 169,296)p=0.23; 6-month Cr 173μmol/L (IQR 152,175) vs 216μmol/L (IQR 149,295)p=0.18). Admission to a neonatal unit or neonatal intensive care unit also tended to be lower with dietary nitrate compared to standard care(7/30(23.3%) v 21/53(39.6%) p=0.13). Seven women receiving dietary nitrate (23.3%) experienced 11 serious adverse events (SAE) compared with 27 women...