Nicotinic Acid and Nicotinamide: A Review of Their Use for Hyperphosphatemia in Dialysis Patients

Abstract

Phosphate binders have traditionally been used to treat hyperphosphatemia, a common complication in patients with end stage renal disease (ESRD). New evidence suggests that nicotinic acid and its metabolites may effectively decrease phosphorus absorption in the gastrointestinal tract, thereby reducing serum phosphorus concentrations. We conducted a literature search to identify studies of patients with ESRD on dialysis that evaluated the role of niacin and related compounds in decreasing serum phosphorus levels. We searched PubMed using the search terms niacin, nicotinic acid, niacinamide, nicotinamide and hyperphosphatemia. Limits were set to include only those articles published since 2002, conducted in human subjects, and written in the English language. Review articles captured through this process were mined for references to other primary literature that may not have been returned through the initial search. All studies were included if they met the search criteria and were conducted in patients with ESRD who received either hemodialysis or peritoneal dialysis. To identify current, ongoing studies, another search was conducted through clinicaltrials.gov. Among the seven studies that met our exclusion criteria, three used nicotinic acid as the therapeutic intervention and four used nicotinamide. Both nicotinic acid and nicotinamide were effective in significantly reducing serum phosphorus concentrations in patients with ESRD on either hemodialysis or peritoneal dialysis. Additional, large-scale studies that assess the appropriate dose as well as long-term safety and efficacy are recommended before clinicians can confirm their place in therapy.

Niacin as a drug repositioning candidate for hyperphosphatemia management in dialysis patients

“…Recruiting patients with a higher phosphorus level at baseline may help researchers to readily identify the significance of hypophosphatemic effects of interventions. 34 To evaluate the sustainability of niacin’s therapeutic effects, long-term follow-up of patients is recommended. Lastly, potential confounders, such as dietary phosphorus intake, other phosphate binder use, and concurrent statin therapy, are required to be adequately controlled.…”

The Molecular Biology and Pathophysiology of Vascular Calcification

“…128,129 Moreover, a number of practical measures have the potential to moderate serum phosphate levels by minimizing the amount of phosphate absorbed from the diet: choosing a plant-based diet, in which a high proportion of the phosphate is tied up in poorly absorbable phytates; avoiding soft drinks and processed foods that contain phosphate additives; employing phosphate-binding drugs such as sevelamer or lanthanum carbonate, as is commonly done in treatment of chronic renal disease; magnesium supplementation; and treatment with sustained-release niacin, which appears to decrease gastrointestinal expression of a prominent phosphate transport protein. [128][129][130][131][132][133][134][135][136][137][138][139][140] Vitamin K and Vitamin D Vitamin K can favorably influence VC, as posttranslational γ-carboxylation of MGP, catalyzed by a vitamin K-dependent enzyme, is crucial to MGP's ability to antagonize VC. 141,142 This presumably explains why use of the vitamin K-antagonist drug warfarin is associated with increased risk for VC.…”

Niacin nutrition and rumen-protected niacin supplementation in dairy cows: an updated review

“…Additionally, the kinetics of niacin supplementation in dairy cows is not completely clear. In humans, the maximal plasma concentration of nicotinic acid is reached after 30-60 min when administered orally (22) , and the plasma half-life of nicotinic acid is about 20-45 min, whereas the half-life of nicotinamide is about 4 h (23) . In dairy cows, the half-life of nicotinamide could probably be longer than 4 h, because Zimbelman et al (18) found the serum niacin concentration returned to presupplementation values by 3 d after a dose of 12 g/d RPN supplementation.…”