Low-dose niacin may reduce phosphorus levels in hemodialysis (HD) patients, a new study finds.

Narges-Sadat Zahed, MD, and colleagues at Shahid Beheshti University of Medical Sciences in Tehran, Iran, and colleagues, tested the potential of low-dose nicotinic acid in a double-blind trial of 70 HD patients with hyperphosphatemia at Ashrafi Esfehani Hospital from May 2013 to April 2014.

The investigators randomly assigned half of the patients to once-daily niacin and half to placebo for 12 weeks. The intervention group received a starting niacin dose of 25 mg/day. If serum phosphorus levels failed to fall below 5.5 mg/dL, the dose was titrated to 50 mg/day after 4 weeks and to 100 mg/day at the end of week 8. All patients also received 1500 mg of calcium carbonate as a phosphate binder during the study because a washout period was not permitted by the ethics committee. The dose of phosphate binder was changed during the study when it was necessary to accommodate niacin at the specified dose.

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The low-dose niacin group experienced notable phosphorus reduction over 12 weeks, according to results published in the Indian Journal of Nephrology. Average phosphorus level decreased from 6.7 mg/dL by week 4 to 5.8 mg/dL by week 8 to 4.4 mg/dL by week 12. The placebo group, by comparison, saw a rise in phosphorus level from 6.5 mg/dL to 7.2 mg/dL by the end of week 12.

Consistent with previous research, niacin treatment also increased high density lipoprotein (HDL) levels from 45.0 to 47.2. None of the participants had received statins or resins.

Previous studies have shown that niacinamide and niacin can reduce serum phosphate levels in dialysis patients. The current findings complement these studies:

“We conclude that niacin (100 mg/day) decreased phosphorus serum level and increased HDL serum level in patients on dialysis,” Dr Zahed and colleagues wrote.

With regard to adverse effects, 1 patient taking niacin experienced flushing. No patients experienced significant changes in calcium or parathyroid hormone levels.

As this study involved a small number of participants of Iranian descent, the effects might stem from their genetic background or diet. The investigators encouraged future prospective, double-blind studies involving larger populations and longer follow-up. 


1. Zahed NS, Zamanifar N, and Nikbakht H. Effect of low dose nicotinic acid on hyperphosphatemia in patients with end stage renal disease. Indian J Nephrol. 2016 Jul 15. [Epub ahead of print]