Niacin lowers serum phosphate and increases HDL cholesterol in dialysis patients.
OBJECTIVE
Adverse effects complicate the use of drugs that are prescribed for phosphate control in dialysis patients. Alternative treatment options are needed.


METHODS
Nicotinic acid inhibits intestinal phosphate reabsorption and increases HDL cholesterol. This study tested the phosphate-lowering and HDL-increasing effect of Niaspan (prolonged-release nicotinic acid) in patients who were undergoing dialysis. Efficacy, safety, and tolerability of Niaspan were prospectively studied. Twenty dialysis patients, who were receiving a stable dosage of a calcium salt-containing drug for phosphate control, received after a 2-wk washout period Niaspan for 12 wk. Patients were started on 375 mg/d, and the dosage was increased every 2 wk to achieve 500, 1000, 1500, and 2000 mg/d, respectively. Clinical and laboratory parameters were prospectively recorded in patients who tolerated a target dosage of > or = 1000 mg/d.


RESULTS
Seventeen patients tolerated > or = 1000 mg/d Niaspan (mean dosage 1470 +/- 110 mg/d). Niaspan treatment for 12 wk decreased serum phosphate values from 7.2 +/- 0.5 to 5.9 +/- 0.6 mg/dl (P < 0.015). In contrast, Niaspan did not affect serum calcium levels. A significant increase in HDL cholesterol from 40 +/- 3.2 to 59 +/- 5.5 mg/dl (34%) was also observed with Niaspan (P = 0.0005).


CONCLUSIONS
Niaspan effectively lowered serum phosphate levels and significantly increased HDL cholesterol. Niaspan may provide an alternative or adjunctive treatment option in dialysis patients.
Müller
Daniela
D
Franz Volhard Clinic, Department of Nephrology and Hypertension, Medical Faculty of the Charité, HELIOS-Klinikum-Berlin, Berlin, Germany.
Mehling
Heidrun
H
Otto
Björn
B
Bergmann-Lips
Regine
R
Luft
Friedrich
F
Jordan
Jens
J
Kettritz
Ralph
R
D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D003692:Delayed-Action Preparations; D005260:Female; D005483:Flushing / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000009:adverse effects / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis
D008076:Cholesterol, HDL; D003692:Delayed-Action Preparations; D010281:Parathyroid Hormone; D010710:Phosphates; D009525:Niacin; D002118:Calcium