CKD Stage 3 Patients Benefit from Extended-Release Niacin
LAS VEGAS—New findings confirm the phosphorus-lowering effects of extended-release niacin in fixed-dose combination with laropiprant (ERN-L) in dyslipidemic patients with stage 3 chronic kidney disease (CKD).
A team led by Andrew G. Bostom, MD, of Rhode Island Hospital in Providence, evaluated the impact of the treatment compared with placebo in 261 such patients pooled from two randomized, controlled trials. Subjects had a baseline estimated glomerular filtration rate of 30-59 mL/min/1.73 m2. Patients received one tablet daily of ERN-L (1 g ERN/20 mg L) for the first four weeks and then two tablets once daily (177 patients), or matched placebo (84 patients).
At baseline, the ERN-L group and placebo group had a mean serum phosphate level of 3.46 and 3.57 mg/dL, respectively. From weeks 12-24, the ERN-L group experienced a sustained significant 0.42 mg/dL mean decrease compared with the placebo recipients, the investigators reported at the National Kidney Foundation's Spring Clinical Meetings.
The investigators concluded that their findings have therapeutic implications for the management of hyperphosphatemia as well as the possible prevention of cardiorenal outcomes in CKD among the large population of patients with stage 3 CKD. The study demonstrated that lowering phosphorus in the normal range can be achieved in stage 3 CKD patients with once-daily dosing, Dr. Bostom pointed out. This is a big advantage over the standard binder treatment requiring thrice-daily dosing, which often fails to lower phosphorus in this particular range.
“If the hypothesis that phosphorus lowering in stage 3-4 CKD patients, even if they have a relatively normal phosphorus [level], might contribute to reduction of cardiovascular disease outcomes, niacin would probably be the preferred therapy,” Dr. Bostom said.