Dialysis niacin

Vitamin requirements for ESKD patients receiving dialysis differ from those of a healthy person because of dietary modifications, kidney dysfunction, and dialysis therapy. The plasma concentrations of vitamins A and E are elevated in ESKD, while those of the water-soluble vitamins (81,82,8g, 812, niacin, pantothenic acid, folic acid, biotin, and vitamin C) tend to be low in this population, in large part due to the fact that many are dialyzable. The goal for vitamin supplementation in this population should be to prevent subclinical and frank deficiency and to avoid pathology from overdosage. Special vitamin supplements have been formulated for the dialysis population, which primarily include 8 vitamins with C and folic acid. 

Niacin requirements are also affected by diseases or conditions interfering with niacin absorption and/or processing, such as prolonged diarrhoea, chronic dialysis treatment, chronic colitis (particularly ulcerative colitis), cirrhosis of the liver, tuberculosis of the gastrointestinal tract, malignant carcinoid tumour and chronic alcoholism (Food and Nutrition Board 1998). Substantial individual differences (about 30%) in the conversion efficiency of tryptophan to niacin have been reported (Horwitt et al. 1981). 

Muller et al. 2007 Niaspan treatment in 17 patients on dialysis for 12 weeks decreased serum phosphate values from 7.2 0.5 to 5.9 — 0.6mg/dl ip < 0.015). Cho et al. 2009 Niacin administration in a rat reduced MCP-1, plasminogen activator inhibitor-1 (PAI-1), transforming growth factor beta (TGF-P), p47(phox), p22(phox), cyclooxygenase-1 (COX-1), and NF-kB activation, ameliorated hypertension, proteinuria, glomerulosclerosis and tubulointerstitial injury. 

Muller, D., Mehling, H., Otto, B., Bergmann-Lips, R., Luft, F., Jordan, J., and Kettritz, R., 2007. Niacin lowers serum phosphate and increases HDL cholesterol in dialysis patients. Clinical Journal of the American Society of... 

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