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Niacin Benefits Kidney Mortality

The proportion of patients experiencing a rapid decline in estimated glomerular filtration rate (eGFR) can be decreased significantly with niacin, as can all-cause mortality…

Elani Streja, PhD Chief investigator, University of California, Irvine Medical Center, commented on the study, stated, “Across all models of adjustment, patients who took niacin had an 11% decreased risk of death.” These results are in contrast with those seen in the AIM-HIGH and HPS-2 THRIVE studies. A meta-analysis of those studies found a 10% increased risk for all-cause mortality (risk ratio, 1.10; 95% confidence interval, 1.00 – 1.20). In addition, there were increased risks for serious adverse effects with niacin.

Niacin has been shown to decrease reactive oxygen species, inflammation, hypertriglyceridemia, hyperphosphatemia, and endothelial dysfunction — all factors associated with a decline in eGFR. However, it is not clear whether niacin can actually slow the decline in eGFR.

In an observational study, the researchers compared 119,891 US Department of Veterans Affairs (VA) patients who were prescribed niacin in 2005 and 2006 with 3,233,579 VA patients who were never prescribed niacin. A decline in eGFR was defined as an annual decrease of more than 5 mL/min per 1.73 m².

At baseline, all patients had normal eGFR. However, niacin patients had a higher body mass index than non-niacin patients (31 vs 29 kg/m²), lower high-density-lipoprotein cholesterol levels (39 vs 46 mg/dL), higher triglyceride levels (214 vs 148 mg/dL), and more use of ACE inhibitors, angiotensin receptor blockers, and statins.

Niacin patients were also older than non-niacin patients (63 vs 60 years), were less likely to be black (9% vs 18%), and had more hypertension, diabetes, atherosclerotic cardiovascular disease, and congestive heart failure.

Over a median follow up of 7.7 years, a decline in eGFR was less common in niacin than in non-niacin patients (odds ratio, 0.88) after adjustment for demographic, laboratory, and clinical variables, comorbidities, and the use of ACE inhibitors, angiotensin receptor blockers, and statins.

The strengths of this study include its large sample, which consisted of a nationally representative contemporary cohort, and its long follow-up period, Dr. Streja said. “We’ve got already two randomized controlled clinical trials that showed the serious side-effect profile of niacin and even increased mortality. Now we get a retrospective study showing benefit, and it’s difficult to believe that it might be true,” he explained.

Practice Pearls:

  • Across all models of adjustment, patients who took niacin had an 11% decreased risk of death
  • Niacin has been shown to decrease reactive oxygen species, inflammation, hypertriglyceridemia, hyperphosphatemia, and endothelial dysfunction — all factors associated with a decline in eGFR.
  • Over a median follow up of 7.7 years, a decline in eGFR was less common in niacin than in non-niacin patients (odds ratio, 0.88) after adjustment for demographic, laboratory, and clinical variables, comorbidities, and the use of ACE inhibitors, angiotensin receptor blockers, and statins.

Kidney Week 2014: American Society of Nephrology Annual Meeting: Abstract TH-OR052. Presented November 13, 2014.