Nicotinic Acid May Improve Hyperphosphatemia in HD

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Meta-analysis shows that nicotinic acid could be a good alternative or add on to traditional phosphate binders, but it is associated with a high rate of adverse events.
Meta-analysis shows that nicotinic acid could be a good alternative or add on to traditional phosphate binders, but it is associated with a high rate of adverse events.

Nicotinic acid and its analogs and derivatives can significantly reduce serum phosphorus levels in hemodialysis patients, according to a new study. These compounds may be associated with a high rate of adverse events, however.

In a meta-analysis of 12 preclinical and clinical trials, serum phosphorus concentration significantly declined during 4 to 8 weeks of treatment, but not afterward, Xianhua Liu, MD, and colleagues reported in Medicine. The calcium × phosphorus product declined significantly during all drug exposure time settings (4, 8, and 12 weeks), with no rebound effect.

Niacin treatment also appeared to improve lipid profile. Mean levels of high-density lipoproteins increased and triglycerides decreased significantly after 8 weeks.

The team found that 41% of patients experienced an adverse effect from treatment, with 8% of patients experiencing diarrhea. The researchers suggested that future studies investigate nicotinic acid's long-term safety.

“Our results suggest that nicotinic acid is probably effective in reducing serum phosphorus levels of dialysis patients,” Dr Liu and the team concluded. “It can be a good alternative (or add on) to the traditional phosphate binders, with a different action mechanism, requires limited exposure time, and has additive antilipemic effects.”

Reference

Liu X, Yang R, Dai B, Zhang H, Wang J, and Ma N. Nicotinic acid and related compounds: A meta-analysis of their use for hyperphosphatemia in dialysis patients. Med. doi:10.1097/MD.0000000000010117

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