Safety and efficacy of nicotinamide in the management of hyperphosphatemia in patients on hemodialysis

Abstract

Hyperphosphatemia is an important modifiable risk factor for death and cardiovascular events in patients on hemodialysis (HD). As nicotinamide has been shown as an inhibitor of sodium–dependent phosphate co–transport in rat renal tubule and small intestine, we examined whether nicotinamide reduces hyperphosphatemia in patients undergoing HD. The study was conducted in 30 end-stage renal disease (ESRD) patients [20 (66.7%) males and 10 (33.3%) females; mean age 54 ± 14.9 years] undergoing twice/thrice weekly HD for more than 3 months. Patients on other phosphate binders were given a 2-week wash-out period. Nicotinamide 250 mg capsules were given twice daily for 25 patients with serum phosphorus greater than 5 mg/dL and thrice daily for 5 patients with serum phosphorus greater than 8 mg/dL immediately after food for 8 weeks. Serum phosphate and calcium levels were estimated every month prior to HD session, and complete blood count, blood sugar, renal profile, liver function tests were estimated at beginning and end of the study. Patients were regularly monitored for side effects. There were significant decreases in the serum phosphate (6.85 ± 1.35 mg/dL at the baseline to 5.74 ± 1.18 mg/dL at the 4th week and to 4.54 ± 0.86 mg/dL at the 8th week), the serum calcium-phosphorus product (57.8 ± 12.21 at the baseline to 48.3 ± 10.71 on 4th week and to 38.201 ± 8.21 at the 8th week), and alkaline phosphatase levels (130.23 ± 50.13 IU/L at the baseline to 116.40 ± 48.27 IU/L after 8 weeks) on treatment with nicotinamide (P < 0.001). Other parameters remained unchanged. Watery stools reported by seven patients resolved during the course of the therapy. Nicotinamide is safe, cheap and effective in controlling serum phosphorus, Ca × P product and alkaline phosphatase levels in patients on maintenance HD.

Barrier protective use of skin care to prevent chemotherapy-induced cutaneous symptoms and to maintain quality of life in patients with breast cancer

“…Additionally, some cases of early termination can be attributed to chemotherapy-induced alterations of sweat gland functions (hyperhidrosis) and the olfactory sense (dysosmia). The present study data and published data raise no safety concerns for clinical use 47–49. Furthermore, niacinamide has been used systemically as a perfusion enhancer for palliative care in patients with breast cancer due to its relaxant effects on vascular smooth muscle cells 50,51…”

Barrier protective use of skin care to prevent chemotherapy-induced cutaneous symptoms and to maintain quality of life in patients with breast cancer

“…The present study data and published data raise no safety concerns for clinical use. [47][48][49] Furthermore, niacinamide has been used systemically as a perfusion enhancer for palliative care in patients with breast cancer due to its relaxant effects on vascular smooth muscle cells. The results of this study suggest that cytostatic cutaneous symptoms among other health problems have a negative impact on quality of life for the patients.…”

Efficacy and safety of nicotinamide in the management of hyperphosphatemia in pediatric patients on regular hemodialysis

“…NAM is now known to inhibit sodium/phosphorous transport in both renal and intestinal brush borders, stimulating interest in its use for phosphorus reduction among patients with ESRD. As a result, there is solid experimental evidence that NAM decreases phosphorus levels in HD patients [12][13][14][15][16][18][19][20][21][22][23].…”

“…Our results correlate with those reported by Cheng et al [19] and Young et al [20] which demonstrated that NAM lowers serum phosphorus levels in maintenance HD patients when co-administered with other phosphate binders. On the other hand, Takahashi et al [16], Sampathkumar et al [21] and Vasantha et al [22] reported that NAM reduces serum phosphorus even when traditional binding agents were withheld.…”