Niacin Benefits Kidney Mortality

http://www.diabetesincontrol.com/articles/53-diabetes-news/17253-niacin-benefits-kidney-mortality#unused

The proportion of patients experiencing a rapid decline in estimated glomerular filtration rate (eGFR) can be decreased significantly with niacin, as can all-cause mortality...

Elani Streja, PhD Chief investigator, University of California, Irvine Medical Center, commented on the study, stated, "Across all models of adjustment, patients who took niacin had an 11% decreased risk of death." These results are in contrast with those seen in the AIM-HIGH and HPS-2 THRIVE studies. A meta-analysis of those studies found a 10% increased risk for all-cause mortality (risk ratio, 1.10; 95% confidence interval, 1.00 - 1.20). In addition, there were increased risks for serious adverse effects with niacin.

Niacin has been shown to decrease reactive oxygen species, inflammation, hypertriglyceridemia, hyperphosphatemia, and endothelial dysfunction -- all factors associated with a decline in eGFR. However, it is not clear whether niacin can actually slow the decline in eGFR.

In an observational study, the researchers compared 119,891 US Department of Veterans Affairs (VA) patients who were prescribed niacin in 2005 and 2006 with 3,233,579 VA patients who were never prescribed niacin. A decline in eGFR was defined as an annual decrease of more than 5 mL/min per 1.73 m².

At baseline, all patients had normal eGFR. However, niacin patients had a higher body mass index than non-niacin patients (31 vs 29 kg/m²), lower high-density-lipoprotein cholesterol levels (39 vs 46 mg/dL), higher triglyceride levels (214 vs 148 mg/dL), and more use of ACE inhibitors, angiotensin receptor blockers, and statins.

Niacin patients were also older than non-niacin patients (63 vs 60 years), were less likely to be black (9% vs 18%), and had more hypertension, diabetes, atherosclerotic cardiovascular disease, and congestive heart failure.

Over a median follow up of 7.7 years, a decline in eGFR was less common in niacin than in non-niacin patients (odds ratio, 0.88) after adjustment for demographic, laboratory, and clinical variables, comorbidities, and the use of ACE inhibitors, angiotensin receptor blockers, and statins.

The strengths of this study include its large sample, which consisted of a nationally representative contemporary cohort, and its long follow-up period, Dr. Streja said. "We've got already two randomized controlled clinical trials that showed the serious side-effect profile of niacin and even increased mortality. Now we get a retrospective study showing benefit, and it's difficult to believe that it might be true," he explained.

Practice Pearls:

Across all models of adjustment, patients who took niacin had an 11% decreased risk of death.

Niacin has been shown to decrease reactive oxygen species, inflammation, hypertriglyceridemia, hyperphosphatemia, and endothelial dysfunction -- all factors associated with a decline in eGFR.

Over a median follow up of 7.7 years, a decline in eGFR was less common in niacin than in non-niacin patients (odds ratio, 0.88) after adjustment for demographic, laboratory, and clinical variables, comorbidities, and the use of ACE inhibitors, angiotensin receptor blockers, and statins.

Kidney Week 2014: American Society of Nephrology Annual Meeting: Abstract TH-OR052. Presented November 13, 2014.

Thanks for this post Yoly.

As I've said before I'm not a medical expert .....but from school days and reading about vitamins I've always thought Niacin is one of the many important 'B' vitamins. So I used 'Wiki' and sure enough my memory served me right.  

Niacin is Vitamin B(3). The article also said that "Although high doses of niacin may elevate blood sugar, thereby worsening diabetes mellitus, recent studies show the actual effect on blood sugar to be only 5–10%. Patients with diabetes who continued to take anti-diabetes drugs containing niacin did not experience major blood glucose changes. Thus overall, niacin continues to be recommended as a drug for preventing cardiovascular disease in patients with diabetes."

So could Niacin assist with preventing both cardiovascular disease and an improvement with kidney function?

All the best Jan

For niacin (nicotinic acid) to reduce CVD by reducing cholesterol you need at least one gram or more. It has many effects in the body including flushing at high dosage. It help reduce triglycerides and increase HDL. It may work to reduce CVD by others means other than cholesterol reduction. At this high dosages is a drug an I would not recommend anyone using them they do have many side effects. As you found out one of them is that they may increase insulin resistance. At normal dosage it can be therapeutic as is an essential vitamin. That it can be used to treat kidney disease is novel and if facing such a complication it will certainly be good idea to consider. You may not need the same big dosage as for cholesterol reduction.

(The negative study findings about niacin that is commented in the news is in combination with another drug to reduce flushing plus taken along with statins. So is hard to attribute all negatives side effects of it to niacin.)

I may now start taking a supplement containing Niacin (Vit B1) as my eGFR level is not great...would be interesting to see if in the future I can achieve a level over 60.

Niacin is vitamin B3 Paul. B1 is Thiamin - another very valuable supplement. Many people have sub-clinical Beri-beri without realising it, especially if they suffer with any neuropathic issues.

There are different forms of Niacin. True niacin, which is the flushing variety and synthetic niacinamide.

Whilst it feels a bit weird, the true flushing niacin is the better option, as the flushing sensation is actually opening up and 'flushing out' the tiny capillaries. Many body builders like to use it in fairly high doses, but it is not necessary to take any more than 100mg.

I buy 100mg tablets from Holland & Barrett and break them in half. I don't like the flush, but I do take a half tablet now and again. I get a mild flush that lasts about 5 minutes. Usually its just my head and face, but when I was doing it more regularly and taking the whole tablet I had some flushes that went right through my body down to my feet too.

It can sometimes take a little while of taking it before you start to get a flush. But some people flush first time. It depends on how well the body can use it. As it is water soluble I find I am more likely to get a flush when taking it with water rather than anything milky or with fatty food.

The flush also helps the body to release retained radiation, both from the sun in Summer and from electrical equipment/X-rays, etc. The less radiation in the body, the less severe the flush.

Can you get these vitamins in food source rather than a supplement or does the dose need to be high ? I don't take supplements at present as I like to think I eat a balanced diet.

Tuna,Chicken,Turkey,Salmon,Lamb,Beef,Sardines,Peanuts,coffee,Asparagus and broccoli are all good sources of niacin and apart from the peanuts,are all good low carb sources.

Paul wrote:Tuna,Chicken,Turkey,Salmon,Lamb,Beef,Sardines,Peanuts,coffee,Asparagus and broccoli are all good sources of niacin and apart from the peanuts,are all good low carb sources.

I think as well as asparagus and broccoli you can add spinach, kale and chile peppers to this list.

All the best Jan

So, if we ate those foods, why would we need to supplement ?

mo1905 wrote:So, if we ate those foods, why would we need to supplement ?

I guess a lot of diabetics who follow the NHS/DUK for dietary advice base a lot of their diet on grains and starchy veg and don't eat as much of the good stuff that we on here do.

Although I may consider supplementing on top as I don't absorb nutrients as well as other folks due to a IBD condition and I already have to have vit B12 injections every 3 months.

Thanks Paul :-)

I was thinking maybe I am deficient because of malabsorption, but since watching Jason Fung's video on diabetes on Youtube, I am thinking it may well be because a diabetic's body needs more of those elements to try and deal with the sugar.

It is interesting that slow-rise bread dough (proved for 12 hours plus) will generate up to 50% more nutrition than quick bread. The action of the yeasts on the flour and water is a catalyst for much higher levels of B vitamins and other elements. Whilst neither I nor my husband can tolerate shop bread, we can eat slow-rise bread without any problems (I don't eat much very often. He can, but he's not diabetic), which suggests the extra vitamins are contributing to far better digestion of it.

Most elements, especially B vitamins, are needed in the digestive process. Poor sugar metabolism obviously must impact on the digestion in some way, so the likelihood of our bodies needing more B vitamins, etc., as a result has to be pretty much a given.

It seems likely then that under normal non-diabetic conditions what we get in food could possibly be enough as long as we are not eating heaps of carbs and sugar, but because of our metabolism issues, we very probably need extra. If the bread and wheat-ridden foods are robbing the body of these elements rather than providing them, something eventually has to give....

Yes Ali thank you that makes a lot of sense to me.