Takahashi Rina, Bui Thuy-Anh, Elali Ibrahim, Tran Diana, Sumida Keiichi, Thomas Fridtjof, Dukkipati Ramanath, Shah Anuja, Rhee Connie M, Kovesdy Csaba P, Kalantar-Zadeh Kamyar, Takahashi Rina
Los Angeles County Harbor-UCLA Medical Center, and The Lundquist Institute, Torrance, California, USA.
Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, USA.
Am J Nephrol. 2025;56(4):457-467. doi: 10.1159/000543098. Epub 2025 Jan 27.
Niacin is a non-statin lipid-lowering therapy that has been shown to lower triglycerides and improve other risk factors for renal outcomes. Despite these favorable data, the effect of niacin on long-term kidney outcomes remains unclear. The aim of this study was to examine the associations of niacin therapies with incident chronic kidney disease (CKD), end-stage renal disease (ESRD), and death in patients with estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2.
In a nationwide historic cohort of 1,139,630 United States (US) veterans with normal baseline eGFR, we examined the association of de novo prescription of niacin with incident CKD (defined as eGFR <60 mL/min/1.73 m2 on two occasions, separated by ≥90 days), ESRD (defined as the initiation of kidney replacement therapy), and death. Associations were examined in Cox proportional hazards models adjusted for demographics, major comorbidities, laboratory measurements, and medications. Prescription time-distribution matching was used to control for survival bias.
We identified 133,450 new users of niacin. Overall, patients (n = 1,139,630) had a mean (standard deviation) age of 60 (13) years, with 6% female, 78% white, 16% black, and 6% Hispanic. Niacin users were more likely to be male, white, current, or former smokers, with higher frequencies of comorbidities and statin use. Niacin use (vs. nonuse) was associated with a higher risk of CKD (HR: 1.08, 95% confidence interval:1.07-1.10) but a lower risk of ESRD (0.82, 0.76-0.88) and death (0.90, 0.89-0.91).
In a large national cohort of US veterans with normal kidney function, niacin use was associated with a lower risk of ESRD and death but with a higher risk of incident CKD, which is potentially explained by acute effects on eGFR. Further studies are needed to corroborate the potential benefits of niacin on kidney function and survival.
烟酸是一种非他汀类降脂疗法，已被证明可降低甘油三酯并改善其他肾脏结局风险因素。尽管有这些有利数据，但烟酸对长期肾脏结局的影响仍不明确。本研究的目的是探讨烟酸疗法与估算肾小球滤过率（eGFR）至少为60 mL/min/1.73 m²的患者发生慢性肾脏病（CKD）、终末期肾病（ESRD）及死亡之间的关联。
在一个包含1,139,630名基线eGFR正常的美国退伍军人的全国历史性队列中，我们研究了烟酸新处方与新发CKD（定义为两次eGFR <60 mL/min/1.73 m²，间隔≥90天）、ESRD（定义为开始肾脏替代治疗）及死亡之间的关联。在根据人口统计学、主要合并症、实验室检查结果和用药情况进行调整的Cox比例风险模型中检验关联。采用处方时间分布匹配来控制生存偏倚。
我们确定了133,450名烟酸新使用者。总体而言，患者（n = 1,139,630）的平均（标准差）年龄为60（13）岁，其中6%为女性，78%为白人，16%为黑人，6%为西班牙裔。烟酸使用者更可能为男性、白人、当前或既往吸烟者，合并症和使用他汀类药物的频率更高。使用烟酸（与未使用相比）与CKD风险较高相关（风险比：1.08，95%置信区间：1.07 - 1.10），但与ESRD风险较低（0.82，0.76 - 0.88）及死亡风险较低（0.90，0.89 - 0.91）相关。
在一个大型的美国退伍军人全国队列中，这些退伍军人肾功能正常，使用烟酸与ESRD和死亡风险较低相关，但与新发CKD风险较高相关，这可能由对eGFR的急性影响来解释。需要进一步研究来证实烟酸对肾功能和生存的潜在益处。
