Nicotinic Acid as a Phosphate-lowering Agent in Patients with End-stage Renal Disease on Maintenance Hemodialysis: A Single-center Prospective Study

摘要

Background Hyperphosphatemia increases the risk of mortality and morbidity in patients with end-stage renal disease (ESRD). In addition to dietary restriction and renal replacement therapy, phosphorus-binding agents are the mainstay of treatment. While the use of calcium-containing binders has certain limitations, non-calcium-based binders are expensive?and?not readily available in developing countries. Previous studies on nicotinic acid as a phosphorus-lowering agent have limited data. In this study, we?evaluated the efficacy of nicotinic acid in patients with ESRD on hemodialysis (HD) in Pakistan. Methods Forty-five patients with ESRD on maintenance HD having serum phosphorus levels?5.5 mg/dL were recruited. Nicotinic acid?250 mg was administered with food for?four weeks. All patients with serum phosphorus levels 8 mg/dL were placed on a twice-daily regimen while the rest received it three times a day with meals. Patients were assessed at the beginning and end of the study with serum phosphorus levels. Results Mean age of the sample population was 44.6 ± 13.9 years and 57.8% of participants were male.?Serum phosphorus level before treatment ranged from 5.6 to 10.8 mg/dL (mean, 6.91 ± 1.33). After nicotinic acid therapy, it ranged from 2.60 to 8.70 mg/dL (mean, 5.82 ± 1.40). Mean decrease in serum phosphorus levels with nicotinic acid after one month of treatment was 1.08 ± 1.16 mg/dL (p-value 0.001). Conclusion Nicotinic acid is effective in lowering serum phosphorus levels in patients with ESRD who are under renal replacement therapy with?maintenance HD.