Niacinamide: New Help for People with Advanced Kidney Disease

For people in kidney failure, it is important to lower serum phosphate levels. But that has proven difficult to do. A natural form of vitamin B3 might help.

High levels of phosphate occur in 72.3% of people with kidney failure who are on hemodialysis. That high level of phosphate is associated with an increased risk of death from cardiovascular disease and, overall, from any cause. So it is important to get those levels down.

The main way to do that is to restrict dietary phosphates and prescribe phosphate binding drugs. But even though 90% of people with kidney failure are prescribed phosphate binders, only 50% achieve the recommended phosphate levels.

This new study tried adding niacinamide to the phosphate binder. In the double-blind study, people who were already on phosphate binders added either a placebo or 250mg of niacinamide for 4 weeks and then 500mg for the next 8 weeks.

While phosphate concentrations continued to climb slightly in the placebo group, they went down significantly in the niacinamide group.

This study suggests for the first time that simply adding niacinamide to phosphate binding drugs can safely and significantly reduce serum phosphate concentrations in people on hemodialysis for kidney failure.

Journal of Renal Nutrition. Sep 2024;34(5):454-62.

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