A team led by Csaba P. Kovesdy, MD, of the Memphis Veterans Affairs Medical Center and the University of Tennessee Health Science Center in Memphis, found that niacin treatment was associated with a significant decrease in the proportion of patients with rapid decline in estimated glomerular filtration rate (eGFR) and a significant decrease in all-cause mortality, after adjusting for baseline demographic and comorbidity factors.
Dysfunctional high-density lipoprotein (HDL), increased reactive oxygen species, inflammation, endothelial dysfunction, hypertriglyceridemia, and hyperphosphatemia have been associated with rapid eGFR decline and increased adverse events, the researchers noted.
Niacin has been shown to improve HDL function, enhancing its antioxidant and anti-inflammatory properties, the researchers pointed out. It also improves endothelial function and decreases triglyceride levels and serum phosphorus.
The cohort had normal baseline eGFR in 2005–2006. Of the 3,353,461 veterans in the cohort, 119,891 were prescribed niacin during 2005–2006. The researchers examined baseline use of niacin with slopes of eGFR over a median follow-up of 7.7 years.
In the total cohort, 9.3% of patients had rapid decline in kidney function (eGFR decline less than −5 mL/min/1.73 m2 per year). In a fully adjusted model, the niacin group had a significant 10% decreased odds of an eGFR slope less than −5 mL/min/1.73 m2 per year.