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PreeclampsiaHUPPNCT01828138

Hypertension and Urine Protease Activity in Preeclampsia

A study testing Sodium in people with Preeclampsia and Hypertension, run by Odense University Hospital at 1 site in Denmark.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Preeclampsia (PE) is a common disorder of pregnancy that complicates 4-7% of all pregnancies. It is a serious condition with acute proteinuria and hypertension and varying degrees of edema after 20 weeks of gestation. PE leads to a severe risk of low birth weight because of prematurity with inherent complications. Read more about this study

Who is it for?
Ages 18 to 45 years, women onlyHealthy volunteers can take part
Conditions the study is for
Preeclampsia, Hypertension, Proteinuria
What is being tested?
Sodium
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
35 participants
Where
1 siteDenmark
Study dates
May 2013to Oct 2015
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 45 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Pregnancy week 28-36 (exclusion of patients with previously severe preeclampsia).
  • Singleton pregnancy
  • Preeclampsia- hypertension: repetitive high blood pressures (> 140/80 mm Hg) measured in the consultation and proteinuria (dip test, albumin).
  • Pregnant with microalbuminuria and proteinuria, but without hypertension (and therefore do not meet the diagnostic criteria for preeclampsia) can also be included. Proteinuria is the most important factor.
  • It is still possible to test our hypothesis with possible comorbidity such as diabetes, SLE(systemic lupus erythematosus), rheumatoid arthritis and therefore not a reason for exclusion.
  • pregnancy week 28-36
Show all 10Show fewer
  • Singleton pregnancy
  • Uncomplicated pregnancy
  • woman, not pregnant
  • Matched by age and BMI

Who cannot join

  • Hypertension in pregnancy without proteinuria.
  • Pregestational nephropathy by other unknown reasons.
  • Early severe preeclampsia.
  • Organic or systemic disease of clinical relevance, such as malignancy.
  • Pregnant controls-
  • Hypertension
Show all 12Show fewer
  • Any kind of nephropathy
  • Organic or systemic disease of clinical relevance, such as malignancy.
  • Non-pregnant controls:
  • Hypertension
  • Any kind of nephropathy
  • Organic or systemic disease of clinical relevance, such as malignancy.

Trial locations and contacts

1 site in 1 country.

Denmark1 site
  • Gynelogical Obstetrical Department

    Skejby, Aarhus, 8200

Other trials in Denmark

About this study

Official title: HUPP-study -Hypertension and Urine Protease Activity in Preeclampsia

Preeclampsia (PE) is a common disorder of pregnancy that complicates 4-7% of all pregnancies. It is a serious condition with acute proteinuria and hypertension and varying degrees of edema after 20 weeks of gestation. PE leads to a severe risk of low birth weight because of prematurity with inherent complications. The pathogenesis is unknown but is assumed to involve placental ischemia.The primary placental disorder results in renal glomerular injury. Established PE is associated with paradoxical suppression of the renin-angiotensin-aldosterone system, RAAS.

Despite suppressed RAAS, patients with PE retain NaCl(sodium chloride) after an intravenous isotonic NaCl overload compared to healthy pregnant women on a low NaCl diet. The investigators believe to have data that provide a possible explanation for the overall relationship between proteinuria, NaCl retension, suppression of RAAS, hypertension and underdevelopment of placenta. Earlier data, which the investigators have confirmed, shows abnormal glomerular loss of the enzyme plasmin/plasminogen from plasma to the urine in PE. Active plasmin in urine from patients with nephrotic syndrome and PE activates the epithelial sodium channel ( ENaC ) in renal collecting duct cells. The investigators hypothesize that loss of plasmin/plasminogen are shared for the diseases with proteinuria, including PE, and that plasmin- driven ENaC (epithelial sodium channel) activation is a causal factor in the pathophysiology of established PE. Hyperactive ENaC causes primary renal sodium retention with secondary suppression of the renin-angiotensin-aldosterone system. Aldosterone is recently established as a placental growth factor.

Read more

Plasma-aldosterone levels are significant higher in normal pregnant women. PE is characterized by low aldosterone levels (a discovery the investigators have also confirmed) and by placental underdevelopment.

Study Aim: To test specific hypothesis regarding established PE´s pathophysiological mechanisms.

Study Hypothesis:

  1. Excretion of urine proteases (plasmin/plasminogen) in PE leads to an activation of ENaC and hence RAAS is less NaCl sensitive while the blood pressure is more NaCl sensitive compared to healthy pregnant women.
  2. The degree of aldosterone suppression in PE determines placental development
Read the detailed description

Selection of patients:

The selection of patients is based on outpatients with preeclampsia and patients with normal pregnancies recruited from gynecological-obstetric department, Aarhus University Hospital - Skejby, Denmark. Non- pregnant woman are recruited by posting notices at the workplace. Specifically by office facilities, canteen and in gynecological department at Skejby hospital, Aarhus.

Background information:

Registration of date of birth, sex, weight, height, abdominal circumference, and smoking status will be noted.

Furthermore, we will register current antihypertensive-, diuretic-, antidiabetic- and antiepileptic medicine and other current use of medicine. Also post-partum registration of gestation length, placentas weight and the infant weight will be noted.

Effect variable:

Clinical:

Weight, height, BMI, abdominal circumference. Blood pressure (systolic, diastolic, mean arterial pressure). Weight of placenta, gestation length, Infant weight

Measurements in blood tests:

Se-creatinine, p-Na+, p-K+. P-plasminogen. P-albumin. P-renin concentration (not activity!), angiotensin II, aldosterone and arterial natriuretic peptide (ANP).

Measurements in 50 ml newly "spot urine":

Plasmin, plasminogen, ENaC peptide fragment (analyses in location of development), Proteolytic activity, Prostatin, Creatinine, Na+, K+.

If findings dictate it we may have to examine the following on chosen urine tests:

  • The ability to activate ENaC- current in M-1-collecting duct cells by patch clamp electrophysiology on complete cells.
  • Detection of different proteolytic forms of the ENaC gamma-subunit through antibody.

Measurements in 24- hour urine samples:

Na+/K+ - concentration. Creatinine clearance. Albumin.

Study process:

The three groups, "cases" (patients with preeclampsia) and "pregnant controls" (patients with normal pregnancies) and non pregnant controls ( non pregnant woman), are provided with 10 days of a healthy fully diet with a fixed low- normal NaCl content of 50 -60 mmol Na+/ day. The diet has the same content of calories per kg body weight and has the same content of potassium as far as possible. In this period of time the patients must only consume this diet and regularly drink water. Besides the fixed diet the patients are given a supplement with either sodium or placebo. The sequence is double randomized. The participants ingests either sodium tablets (150-200 mmol /day) or a corresponding number of placebo tablets. On the fifth day, the participants switch their daily supplement, so they now take placebo instead of sodium or the other way around.

Day number 1 is a Monday and day number 5 is a Friday where the measurements are to be done. 24-h urine samples are collected from Thursday 7 a.m. till Friday morning. On the 5th day the participants meet from 9 a.m. to 10 a.m. They are placed in a chair with elevated legs and relaxed for an hour in calm surroundings.

From 7 a.m. they ingest 200 ml water per hour. Spot urine tests are collected. Blood pressure is measured with an automatic oscillometric device. Intravenous access is made and blood samples are taken to decide the plasma hormone concentration (renin, angiotensin, aldosterone, ANP) and albumin, plasminogen and electrolytes. Cardiac output is measured non-invasive by impedance cardiography. Placenta flow is measured by ultrasound. The procedure lasts approximately 2 hours.

Hereafter a fixed, fully diet is given either with a sodium supply, a total of 250 mmol/day (corresponding to a high average sodium intake in Denmark) or placebo tablets. This diet is given in 4 days and measurements are made on the 5th day as described above.

A fixed sodium intake is given to:

  1. Get valid steady-state values for the RAAS- components;
  2. To study reactivity in RAAS components by changes in the NaCl intake
  3. Decide changes in blood pressure during 2 different normal NaCl intakes - low and high normal
  4. Correlate RAAS reactivity to urine excretion of plasmin/plasminogen under the hypothesis at the correlation will be conversely and
  5. Achieve valid values for aldosterone in correlation to the placenta flow. Length of gestation and placenta´s weight is registered at birth.

Data- analysis methods:

Introduction:

This is an interventional double blinded case-control, cross-over study which includes 10 patients with preeclampsia, 10 patients with normal pregnancies and 10 non pregnant woman.

Population size evaluation:

The settings for a Ph.D. study makes it impossible to accomplish a fixed sodium diet intervention in 10 days with the amount of patients required to get a relevant change in the blood pressure detection.

With a paired design it is estimated that to achieve an expected change in blood pressure at approximately 15 mmHg in the individual and a clinical relevant different in blood pressure at 8 mmHg the sample size must include 40 patients (5% percentage point - 90% strength). Therefore we have chosen that blood pressure is not the primary variable of the outcome, instead we choose the RAAS components.

In previously similar designs we have measured hypertensive vs. normotensive patients and had enough statistic strength to detect differences in plasma concentrations of renin-angiotensin-aldosterone components and ANP by using 10 patients in each group.

Being tested
Sodium, Placebo
Keywords
Proteinuria, Pregnancy, Hypertension, Plasmin, Plasminogen, Aldosterone, Angiotensin, Renin, sodium chloride, epithelial sodium channel, Placenta
Medical subject headings
Pre-Eclampsia, Hypertension, Proteinuria

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SodiumDietary supplement

    supplemental sodium tablets 150-200 mmol/day in 5 days

  • PlaceboDietary supplement

    Placebo are given in 5 days

Study groups in NCT01828138
Study groupRoleWhat they receive
PreeclampsiaOtherpatients with preeclampsia are given a diet with a fixed content of sodium chloride ( 50-60 mmol/day ) plus a supplement of sodium chloride tablets ( 150-200 mmol/day) OR they are given placebo tablets. After 5 days they switch their supplement.
Receives: Dietary Supplement: Sodium; Dietary Supplement: Placebo
ControlsOtherControls are given a diet with a fixed content of sodium chloride ( 50-60 mmol/day ) plus a supplement of sodium chloride tablets ( 150-200 mmol/day) OR they are given placebo tablets. After 5 days they switch their supplement
Receives: Dietary Supplement: Sodium; Dietary Supplement: Placebo
not-pregnant womenOtherThis arm is also a control- group. Controls are given a diet with a fixed content of sodium chloride ( 50-60 mmol/day ) plus a supplement of sodium chloride tablets ( 150-200 mmol/day) OR they are given placebo tablets. After 5 days they switch their supplement
Receives: Dietary Supplement: Sodium; Dietary Supplement: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. urine Plasmin/plasminogen correlation to the severity of preeclampsia

    We suggest that the loss of plasmin/plasminogen are shared for the diseases with proteinuria, including PE, and that plasmin- driven ENaC activation is a causal factor in the pathophysiology of established PE. We believe that high concentrations of plasmin/plasminogen in the urine correlates to the severity og preeclampsia.

    -Another outcome measure is the correlation between plasma aldosterone and the placental (under)development.

    Measured: 3 years

Secondary outcomes (2)
  1. correlation between RAAS components in urine and severity of preeclampsia

    Measured: 3 years

  2. Degree of aldosterone suppression in PE determines placental development

    PE is characterized by low aldosterone levels and by an underdeveloped placenta. In established PE, suppression of aldosterone can possibly contribute to an underdeveloped placenta.

    A causal link between the degree of aldosterone suppression and morphological placenta abnormalities is not yet established. We compare blood levels of aldosterone to flow in a. umbilicalis and a.uterine by ultrasound.

    Measured: 3 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Apr 2013 (estimated)
  2. Study startMay 2013
  3. Primary completionOct 2015
  4. Study completionOct 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
35 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01828138
Sponsor's protocol ID
9-5510
Acronym
HUPP
Status last verified
Oct 2015
First submitted
5 Apr 2013
Last updated
16 Oct 2015
Results posted
No
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing Sodium in people with Preeclampsia and Hypertension, run by Odense University Hospital at 1 site in Denmark.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Oct 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Denmark. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

urine Plasmin/plasminogen correlation to the severity of preeclampsia (time frame: 3 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Oct 2015.

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