ABSTRACT
Objective To study the effectiveness of niacinamide in treating maintenance hemodialysis patients with hyperphosphatemia.Methods It was a prospective and randomized controlled trial.Patients with hyperphosphatemia (serum phosphate ＞ 1.45 mmol/L) were randomly assigned into two groups:control group (continue their original phosphate binder and rocaltrol treatment) and niacinamide therapy group (additionally received niacinamide,titrated from 600 mg/d to 1200 mg/d).The treatment lasted for 8 weeks.Serum phosphate and calcium were tested every 2 weeks and normalized protein catabolic rate and other relevant indexes were tested monthly.Results 100 patients were recruited and 93 of them completed the trial,including 44 from the therapy group and 49 from the control group.By the repeated measures analysis of variance,changes of serum phosphate in two groups displayed a statistical significant difference,but the levels of serum calcium in both remained steady.At the end of trial,compared to control group,therapy group appeared decreased serum phosphate levels [(1.59±0.36) mmol/L vs (1.94±0.25) mmol/L,P ＜ 0.001] and increased serum HDL levels [(1.32±0.54) mmol/L vs (1.09±0.41) mmol/L,P=0.02].Meanwhile,two groups showed no significant difference in intact parathyoid hormone and alkaline phosphatase.Adverse reactions including thrombocytopenia and gastrointestinal dysfunction were observed in niacinamide therapy group.Conclusions Niacinamide is effective on controlling hyperphosphatemia along with phosphate binder in maintenance hemodialysis patients.It also increases the serum HDL levels.Nonetheless,it is important to monitor the number of platelet.