Abstract
Introduction: 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. Methods: 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. Results: 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). Conclusions: 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.
Plain Language Summary
In this study, we evaluated the impact of niacin on chronic kidney disease (CKD), end-stage renal disease (ESRD), and death. Niacin is a non-statin lipid-lowering therapy, but its impact on long-term renal and life prognosis has not been well studied. Using a national historical cohort of 1,139,630 United States (US) veterans with normal renal function, we analyzed the association between de novo niacin prescription and outcomes (CKD, ESRD, death). The analysis showed that patients who used niacin had an 8% higher risk of CKD (HR: 1.08, 95% confidence interval [CI]:1.07–1.10) but an 18% lower risk of ESRD (0.82, 0.76–0.88) and a 10% lower risk of death (0.90, 0.89–0.91) than nonusers. The results suggest that niacin use reduces the risk of ESRD and death, but further studies are needed to support the causal relationship and its benefits.
