Niacin and Chronic Kidney Disease

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  • TAKETANI Yutaka
    Department of Clinical Nutrition, University of Tokushima Graduate School
  • MASUDA Masashi
    Department of Clinical Nutrition, University of Tokushima Graduate School
  • YAMANAKA-OKUMURA Hisami
    Department of Clinical Nutrition, University of Tokushima Graduate School
  • TATSUMI Sawako
    Department of Molecular Nutrition, University of Tokushima Graduate School
  • SEGAWA Hiroko
    Department of Molecular Nutrition, University of Tokushima Graduate School
  • MIYAMOTO Ken-ichi
    Department of Molecular Nutrition, University of Tokushima Graduate School
  • TAKEDA Eiji
    Department of Clinical Nutrition, University of Tokushima Graduate School
  • YAMAMOTO Hironori
    Department of Clinical Nutrition, University of Tokushima Graduate School Jin-ai University

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Abstract

Chronic kidney disease (CKD) is an increasing problem worldwide. The number of end-stage renal disease patients requiring treatment by dialysis is estimated to be increasing by 10,000 patients per year in Japan. Furthermore, an estimated 13 million people are living with CKD in Japan. Various complications are associated with CKD, including cardiovascular disease (CVD). More than one-third of CKD patients die from CVD. Thus, prevention of CVD is a primary concern for the treatment of CKD patients. CKD-mineral and bone disorder (CKD-MBD) is a serious complication that typically leads to CVD. Hyperphosphatemia is thought to be a central-risk factor for CKD-MBD. Therefore, managing hyperphosphatemia is crucial to prevent CKD-MBD and CVD. It is difficult to achieve the target serum phosphate level through dietary modifications alone in patients with hyperphosphatemia, because most foods contain phosphate. Thus, phosphate binders such as calcium carbonate are commonly prescribed to CKD patients with hyperphosphatemia, but these have undesirable side effects. Inhibition of intestinal phosphate transport activity has also been investigated as an alternative approach for controlling serum phosphate levels in CKD patients. Nicotinamide, which is the amide of niacin, can inhibit intestinal phosphate transport. Niacin and related compounds have also been developed as drugs for hyperlipidemia conditions, especially hypertriglyceridemia with low high-density lipoprotein. This type of dyslipidemia is frequently observed in CKD patients and is a modifiable risk factor for CVD. Thus, niacin and related compounds may have utility for the treatment of both hyperphosphatemia and dyslipidemia in CKD patients to prevent CVD.

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