Chronic Kidney Diseases, Preeclampsia, Pregnancy
Conditions
Keywords
kidney disease, pregnancy, preeclampsia, kynurenine, maternal outcomes, fetal outcomes
Brief summary
Chronic kidney disease (CKD) affects more than 10% of the population worldwide and represents the second most important risk factor for preeclampsia, a life-threatening complication of pregnancy responsible for approximately 80,000 maternal and 500,000 perinatal deaths each year. Experimental studies have suggested a causal link between CKD, relative kynurenine deficiency during pregnancy, and preeclampsia development. Kynurenine, a tryptophan metabolite, plays a central role at the materno-fetal interface, supporting placental energy production, maternal-fetal immune tolerance, and placental perfusion. This study will prospectively assess and compare longitudinal kynurenine concentrations in pregnant women with and without CKD, and evaluate their associations with maternal and fetal outcomes.
Detailed description
This is a multicenter, prospective cohort study including 204 pregnant women, with or without chronic kidney disease (CKD stages 2 to 4). Participants will be enrolled before 14 weeks of gestation. Blood samples (14 mL) will be collected at the 1st, 2nd, and 3rd trimesters and 2 months postpartum for kynurenine measurement, centrally analyzed at CHU Reims using LC-MS/MS. Additional data include maternal demographics, medical and obstetric history, anthropometry, laboratory data (creatinine, hemoglobin, hematocrit, proteinuria), blood pressure, ultrasound (growth parameters, umbilical artery Doppler), and maternal-fetal outcomes (preeclampsia, gestational hypertension, HELLP, hemorrhage, SGA, prematurity, mortality). The primary objective is to compare kynurenine concentrations in the 3rd trimester between women with and without CKD. Secondary objectives include describing longitudinal kynurenine evolution, its association with maternal-fetal outcomes, and modeling kynurenine needs during pregnancy in CKD.
Interventions
OTHERBlood sampling
A 14ml blood sample will be collected during the first second and third trimesters of pregnancy and at 2 months (+ 1 month post partum)
Sponsors
CHU de Reims
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult pregnant women \<14 weeks of amenorrhea * With or without CKD stage 2-4 (eGFR 15-89 mL/min/1.73m², diagnosed before pregnancy) * Written informed consent * Affiliation to a social security system
Exclusion criteria
* Multiple pregnancy * Kidney transplantation * Persons under guardianship or legal protection
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Kynurenine concentration at the 3rd trimester (32±1 weeks) in women with and without CKD | 32±1 weeks |
Secondary
| Measure | Time frame |
|---|---|
| Kynurenine concentrations at 1st, 2nd, 3rd trimesters and 2 months postpartum in women with and without CKD | at 9 months |
| preeclampsia | at 6 months |
| gestational hypertension | at 6 months |
| HELLP syndrome | at 6 months |
| postpartum hemorrhage | at 6 months |
| small-for-gestational-age | at 6 months |
| prematurity | at 6 months |
| fetal/neonatal mortality | at 6 months |
| Modeling of kynurenine needs across pregnancy in CKD women mean kynurenine concentration | at 6 months |
Countries
France
Contacts
CONTACTVincent DUPONT
Outcome results
None listed