Targeting cardiovascular and metabolic risk modification in end stage renal disease (ESRD): a randomized controlled clinical trial on niacin's effects on lipoprotein(a) and biochemical markers in hemodialysis patients.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 41140700 · doi:10.3389/fmed.2025.1625417
What was done
A randomized controlled trial evaluated 50 hemodialysis patients divided equally into two groups (n = 25 each): a control group receiving standard care and an intervention group receiving 500 mg/day niacin alongside standard therapy. Participants were followed for 3 months, assessing blood pressure, phosphorus, parathyroid hormone (PTH), electrolytes (potassium, sodium), uric acid, lipid profiles, and lipoprotein(a) [Lp(a)].
What was found
Niacin stabilized systolic and diastolic blood pressure compared to significant increases observed in the control group. In the niacin arm, phosphorus decreased significantly (5.59 to 4.85 mg/dL, P = 0.0077) while rising in controls. PTH dropped by 60% with niacin but increased by 41.6% in controls (P = 0.001). Potassium fell by 27% with niacin versus a 23.9% rise in controls. Sodium remained stable with niacin but declined in controls, and uric acid remained stable with niacin while rising sharply in controls. Niacin also reduced LDL (31.9% vs. 7.9% in controls), total cholesterol (13.3% vs. 3.7%), and Lp(a) (11.4% decrease). Changes in triglycerides and VLDL did not reach statistical significance in either group.
Why it matters
This study suggests low-dose niacin may act as a multi-target adjunctive therapy in end-stage renal disease, addressing multiple metabolic and cardiovascular risk factors including hyperphosphatemia and dyslipidemia simultaneously.
Limits
The trial had a small sample size (n = 50), a brief 3-month duration, and did not evaluate hard cardiovascular clinical outcomes or safety and adverse events. Blinding and placebo-control details were not reported in the abstract.