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Abstract: FR-PO855

Observational Cohort with Embedded Randomised Controlled Trials to Study Pregnancy-Associated Progression of Renal Disease (ORCHARD)

Session Information

Category: Women's Health and Kidney Diseases

  • 2200 Women's Health and Kidney Diseases


  • Smith, Priscilla, King's College London, London, United Kingdom
  • Dalrymple, Kathryn, King's College London, London, United Kingdom
  • Clark, Katherine Rose, King's College London, London, United Kingdom
  • Wang, Yanzhong, King's College London, London, United Kingdom
  • Harris, Tess M., The PKD Charity, London, United Kingdom
  • Webb, Andrew James, King's College London, London, United Kingdom
  • Chappell, Lucy C., King's College London, London, United Kingdom
  • Bramham, Kate, King's College London, London, United Kingdom

46% of women with moderate-severe chronic kidney disease (CKD) will require dialysis or lose at least 25% of kidney function within six months of delivery with no development of preventative treatments.


Biological samples, longitudinal and outcome data will be collected in a prospective cohort and eligible women identified to participate in ORCHARD-BEET randomised controlled feasibility trial. Inclusion criteria: singleton pregnancies; 24+6 weeks or less; CKD (pre-pregnancy eGFR<90mls/min/m2 or pregnancy Cr>70µmol/l). Randomisation: 1 to 1. Standard care or daily beetroot juice supplement (nitrate 400mg). Primary outcome: recruitment rate; secondary outcomes: tolerability, acceptability, eGFR change at 6 months postpartum.


118 women consented to participate in the cohort and 104 were randomised to ORCHARD-BEET trial. 65% of eligible participants approached consented to be enrolled in the trial. Cohort maternal baseline characteristics are presented in Table 1. Trial results will be reported in 2024 once follow up complete.


To our knowledge this is the largest prospective cohort study with embedded pragmatic feasibility trial with concurrent biobanking of pregnant participants which is representative of women with moderate and severe CKD. Findings will be used to inform future intervention trials to prevent pregnancy associated progression of kidney disease.

ISRCTN 91211980

Table 1.Baseline Characteristics
Baseline CharacteristicCohort(n=118)
Mean (SD)/Median (IQR)/N(%)
Age, yrs34.9(5.3)
Non-White ethnicity51(42.2%)
Gestation weeks at recruitment 17(13,21)
High Deprivation*53(44.9%)
Systolic Blood Pressure121(12.6)
Diastolic Blood Pressure74(9.9)
Pre-pregnancy eGFR (ml/min/1.73m2)56.7(18.6)
Pre-pregnancy uACR (mg/mmol)12.5(2.0,61.4)
Primary cause of renal disease
Polycystic Kidney Disease
Glomerular disease
Reflux nephropathy
Diabetic nephropathy
Renal transplant
Unknown cause/other
Diabetes 13(11%)
Chronic hypertension62(52.5%)

* Index of Multiple Deprivation UK 2019


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