Hypophosphatemic effect of niacin in patients without renal failure: a randomized trial.

Abstract

BACKGROUND AND OBJECTIVES:

Niacin administration lowers the marked hyperphosphatemia that is characteristic of renal failure. We examined whether niacin administration also reduces serum phosphorus concentrations in patients who have dyslipidemia and are free of advanced renal disease.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We performed a post hoc data analysis of serum phosphorus concentrations that had been determined serially (at baseline and weeks 4, 8, 12, 18, and 24) among 1547 patients who had dyslipidemia and were randomly assigned in a 3:2:1 ratio to treatment with extended release niacin (ERN; 1 g/d for 4 weeks and dose advanced to 2 g/d for 20 weeks) combined with the selective prostaglandin D2 receptor subtype 1 inhibitor laropiprant (L; n = 761), ERN alone (n = 518), or placebo (n = 268).

RESULTS:

Repeated measures analysis revealed that ERN-L treatment resulted in a net mean (95% confidence interval) serum phosphorus change comparing ERN-L with placebo treatment of -0.13 mmol/L (-0.15 to -0.13 mmol/L; -0.41 mg/dl [-0.46 to -0.37 mg/dl]). These results were consistent across the subgroups defined by estimated GFR of <60 or > or =60 ml/min per 1.73 m(2), a serum phosphorus of >1.13 mmol/L (3.5 mg/dl) versus < or =1.13 mmol/L (3.5 mg/dl), the presence of clinical diabetes, or concomitant statin use.

CONCLUSIONS:

We have provided definitive evidence that once-daily ERN-L treatment causes a sustained 0.13-mmol/L (0.4-mg/dl) reduction in serum phosphorus concentrations, approximately 10% from baseline, which is unaffected by estimated GFR ranging from 30 to > or =90 ml/min per 1.73 m(2) (i.e., stages 1 through 3 chronic kidney disease).

• Authors: Darbie Maccubbin, Diane Tipping, Olga Kuznetsova, William A Hanlon, Andrew G Bostom
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 5 Issue 4 Pg. 582-9 (Apr 2010) ISSN: 1555-905X [Electronic] United States
• PMID: 20299362 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Biomarkers
• Delayed-Action Preparations
• Hypolipidemic Agents
• Indoles
• MK-0524
• Receptors, Immunologic
• Receptors, Prostaglandin
• Niacin
• Phosphorus
• Calcium
• prostaglandin D2 receptor

Topics

• Aged
• Biomarkers (blood)
• Calcium (blood)
• Chronic Disease
• Delayed-Action Preparations
• Double-Blind Method
• Drug Therapy, Combination
• Dyslipidemias (blood, complications, drug therapy, physiopathology)
• Female
• Glomerular Filtration Rate (drug effects)
• Humans
• Hyperphosphatemia (blood, drug therapy, etiology, physiopathology)
• Hypolipidemic Agents (adverse effects, therapeutic use)
• Hypophosphatemia (blood, chemically induced, physiopathology)
• Indoles (therapeutic use)
• Kidney Diseases (blood, complications, physiopathology)
• Male
• Middle Aged
• Niacin (adverse effects, therapeutic use)
• Phosphorus (blood)
• Receptors, Immunologic (antagonists & inhibitors)
• Receptors, Prostaglandin (antagonists & inhibitors)
• Severity of Illness Index
• Time Factors