Association Between Niacin Intake and Mortality Risks in Chronic Kidney Disease

Аннотация

Background: Chronic kidney disease (CKD) is a global health issue with increasing prevalence and significant disease burden (1, 2). Patients with CKD have a substantially elevated risk of cardiovascular disease (CVD) and all-cause mortality (3, 4). Niacin, or vitamin B3, has been used to manage dyslipidemia, a common condition in CKD, but its effects on mortality in this population are unclear (5, 6, 7, 8, 9, 10, 11, 12). This study investigates the relationship between dietary niacin intake and the incidence of all-cause and cardiovascular mortality among CKD patients. Methods: We conducted a comprehensive review of existing literature, including cohort studies and post-hoc analyses of clinical trials, to evaluate the association between dietary niacin intake and mortality outcomes in CKD patients. Studies were identified through systematic searches of electronic databases. Data on niacin intake, patient characteristics, and mortality outcomes were extracted and synthesized. Results: Several studies suggest a potential link between niacin and mortality in CKD patients. While niacin has shown some benefits in managing dyslipidemia (20, 21, 22, 23, 24, 25), its impact on cardiovascular events and overall survival in CKD patients is complex. Some studies have shown that high doses of niacin did not reduce cardiovascular events and may have increased adverse effects (7, 8). A post-hoc analysis of the AIM-HIGH trial showed that extended-release niacin did not significantly affect cardiovascular events or kidney function in CKD patients (12). Other observational studies suggest a more nuanced relationship, where very low or very high intake might be detrimental (30, International Journal of Medical Science and Public Health Research 01 https://ijmsphr.com/index.php/ijmsphr International Journal of Medical Science and Public Health Research 31, 32, 33, 34). the risk of cardiovascular events (6, 20, 21, 22, 23, 24). However, more recent trials, such as the AIM-HIGH and Conclusion: The relationship between dietary niacin HPS2-THRIVE studies, failed to show a significant benefit intake and the risk of all-cause and cardiovascular of adding extended-release niacin to statin therapy in mortality in CKD patients is not fully elucidated. While reducing cardiovascular events, and raised concerns niacin plays a crucial role in various metabolic about potential adverse effects (7, 8). A meta-analysis processes (28, 29), and dyslipidemia is a key risk factor also questioned the cardiovascular benefits of HDL- in CKD (11, 13), the evidence regarding its impact on targeted therapies, including niacin (9). mortality in this specific population is inconclusive. Further well-designed studies are needed to Given the high prevalence of dyslipidemia and the determine the optimal range of niacin intake for CKD increased cardiovascular risk in CKD patients, it is crucial patients and to assess whether supplementation to understand the role of niacin in this specific provides a net benefit in terms of reducing mortality. population. CKD patients often have unique metabolic abnormalities and may respond differently to lipid- lowering therapies compared to the general population. Keywords: Chronic Kidney Disease, Niacin Intake, A post-hoc analysis of the AIM-HIGH trial specifically Cardiovascular Mortality, All-Cause Mortality, examined the effects of extended-release niacin on Nutritional Epidemiology, Kidney Health, Dietary cardiovascular events and kidney function in CKD Factors. patients, but the results were inconclusive (12). This article aims to review the existing evidence on the Introduction: Chronic kidney disease (CKD) affects a relationship between dietary niacin intake and the substantial portion of the global population, with incidence of all-cause and cardiovascular mortality prevalence and disease burden continuing to rise (1, 2). among patients with CKD. We will examine the potential CKD is characterized by a progressive decline in kidney benefits and risks of niacin in this vulnerable population function, leading to a range of complications, including and identify areas where further research is needed. hypertension, anemia, and mineral and bone METHODS disorders. Importantly, CKD is strongly associated with A comprehensive literature search was conducted using an increased risk of cardiovascular disease (CVD), electronic databases, including PubMed, Scopus, and which is a leading cause of mortality in this patient Web of Science. The search strategy included terms population (3, 4). Traditional cardiovascular risk related to niacin, CKD, and mortality, such as "niacin," factors, such as dyslipidemia, are highly prevalent in "vitamin B3," "chronic kidney disease," "renal CKD and contribute to this elevated risk (11, 13). insufficiency," "end-stage renal disease," Dyslipidemia, characterized by abnormal levels of "cardiovascular mortality," "all-cause mortality," and lipids (fats) in the blood, is a common complication