Niacin's Phosphorus-Lowering Effect Confirmed

Average 6-month serum phosphorus level was significantly lower in CKD patients who received niacin than those who did not (3.4 vs. 4.2 mg/dL).
Average 6-month serum phosphorus level was significantly lower in CKD patients who received niacin than those who did not (3.4 vs. 4.2 mg/dL).

BOSTON—Niacin may be an option for phosphate control in patients with advanced chronic kidney disease (CKD), according to data presented at the National Kidney Foundation's 2016 Spring Clinical Meetings.

A team at Edward Hines, Jr. VA Hospital in Hines, Ill., led by Nicholas J. Burge, PharmD, retrospectively studied 50 patients with advanced CKD: 25 treated with niacin and 25 controls matched according to CKD stage (average age 72 and 74 years, respectively). After excluding non-adherent patients, the average serum phosphorus level over the course of 6 months was significantly lower in the niacin than the control arm (3.4 vs. 4.2 mg/dL), the researchers reported in a poster presentation. They found no significant association between niacin dose and phosphorus level.

The authors noted that studies have shown that niacin lowers serum phosphorus by inhibiting the expression of type IIb sodium-phosphate co-transporters, which are responsible for absorption of phosphate through the gastrointestinal tract.

They stated that niacin has the advantages of daily administration without regard to meals and generic availability.

Commenting on the study, Csaba P. Kovesdy, MD, chief of nephrology at the Memphis VA Medical Center and The Fred Hatch Professor of Medicine at the University of Tennessee Health Science Center in Memphis, stated that the effects of niacin on phosphorus levels are known and accepted, but the new study, which analyzed a real-life scenario in the United States, is novel.

“The study confirms that a low number of patients use niacin in clinical practice, which limits the power of observational studies like the one presented,” said Dr. Kovesdy, who has conducted research on phosphorus control in CKD patients but was not involved in this investigation.

The limited size makes it impossible to account for the presence of confounders, Dr. Kovesdy said. He pointed out that the control arm had a higher proportion of patients receiving vitamin D analogues, which could cause an increase in serum phosphorus.

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