The Effect of Niacinamide Supplementation on Phosphate Concentrations in Dutch Dialysis Patients: A Randomized Crossover Trial.

Autor:	Schepers L; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands., Jans I; Department of Nutrition and Dietetics, Hospital Gelderse Vallei, Ede, the Netherlands, Nutrition & Healthcare Alliance, Ede, The Netherlands., Pot GK; Nutrition & Healthcare Alliance, Ede, The Netherlands., Smilde AJ; Department of Nephrology, Hospital Gelderse Vallei, Ede, The Netherlands., Hofstra JM; Department of Nephrology, Hospital Gelderse Vallei, Ede, The Netherlands., de Roos NM; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands. Electronic address: nicole.deroos@wur.nl.
Jazyk:	angličtina
Zdroj:	Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation [J Ren Nutr] 2024 Sep; Vol. 34 (5), pp. 454-462. Date of Electronic Publication: 2024 Mar 15.
DOI:	10.1053/j.jrn.2024.02.005
Abstrakt:	Objective: Hyperphosphatemia is a common complication in patients with kidney failure, despite the use of phosphate binders. Vitamin B3, either in the form of niacin or niacinamide (NAM), shows potential as "add-on" treatment to reduce serum phosphate concentrations in this population. NAM seems to lack many of the side effects that are observed with niacin. The aim of this study was to investigate whether NAM is an effective and acceptable treatment in reducing serum phosphate concentrations in patients with kidney failure. Methods: DiaNia was a double-blind placebo-controlled randomized crossover trial, comparing NAM (250-500 mg/day) to placebo as "add-on" treatment to an individual treatment with approved phosphate binders for 12 weeks in patients receiving hemodialysis. The primary outcome was serum phosphate concentrations, and the secondary outcomes were platelet counts as well as drop-outs due to side effects. Data were analyzed using both per-protocol and intention-to-treat analyses. Results: Mean age of the per-protocol population (n = 26) was 63.6 ± 17.2 years and 53.8% were men. NAM treatment significantly reduced serum phosphate with 0.59 mg/dL (p = .03). Linear mixed-effects models demonstrated superiority of 12 weeks NAM over 12 weeks placebo with a between-treatment difference of 0.77 mg/dL (95% CI 0.010, 1.43; P = .03). Similar results, although not significant, were found in the intention-to-treat population. We found no between-treatment differences in platelet counts and during the NAM treatment we observed 3 drop-outs due to side effects (8.6%). Conclusion: NAM is effective in reducing serum phosphate concentrations in patients with kidney failure receiving hemodialysis. In addition, NAM is well-tolerated and seems not to increase the risk of thrombocytopenia. Thus, NAM can be valuable as "add-on" treatment to combat hyperphosphatemia in patients with kidney failure. However, more research in larger populations is needed to confirm this. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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