Niacin lowers serum phosphate and increases HDL cholesterol in dialysis patients

Background and objectives: Adverse effects complicate the use of drugs that are prescribed for phosphate control in dialysis patients. Alternative treatment options are needed. Design, setting, participants, & measurements: 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,1000 mg/d. Results: Seventeen patients tolerated 2:1000 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 W < 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.