Therapy
Randomised trial finds niacin lowers Lp(a) by 11.4% and stabilises phosphorus and potassium in 50 hemodialysis patients (Front Med 2025)
Original title: Targeting cardiovascular and metabolic risk modification in end stage renal disease (ESRD): a randomized controlled clinical trial on niacin's effects on lipoprotein(a) and biochemical markers in hemodialysis patients
In a randomised controlled trial, 50 patients on hemodialysis for end-stage renal disease were assigned to standard care alone or standard care plus niacin 500 mg/day, and followed for three months. Blood pressure was stabilised by niacin while it rose in controls. Phosphorus fell significantly with niacin (5.59 to 4.85 mg/dL, P = 0.0077) while rising in controls, PTH fell 60% with niacin versus a 41.6% rise in controls (P = 0.001), and potassium fell 27% with niacin versus a 23.9% rise in controls. Niacin also improved lipid profiles, reducing LDL by 31.9% versus 7.9% with standard care and total cholesterol by 13.3% versus 3.7%, and reduced Lp(a) by 11.4%. The authors conclude niacin offers meaningful adjunctive cardiovascular and metabolic benefit, including modest Lp(a) lowering, in this high-risk dialysis population.
Original abstract
Background: End-stage kidney disease (ESRD) patients on dialysis face pronounced cardiovascular and metabolic risks due to disruptions in lipoprotein(a), phosphorus, potassium, uric acid, and lipid balance. Current therapeutic options offer limited capacity to address these multifaceted abnormalities. Niacin is unique in this regard, as it not only lowers lipoprotein(a) but also influences phosphorus and uric acid metabolism. This study evaluates the efficacy of niacin therapy in improving these biochemical markers, thereby addressing an important therapeutic gap in this vulnerable population.
Methods: In a randomized, controlled trial, 50 hemodialysis patients were divided into two groups of twenty-five each. The control group continued standard care, while the niacin group received 500 mg/day niacin alongside standard therapy. Patients were followed for 3 months.
Results: Systolic and diastolic blood pressure were stabilized by niacin administration, in contrast to the control group, where both parameters rose significantly. Phosphorus decreased significantly in the niacin group (5.59 to 4.85 mg/dL, P = 0.0077), while increasing in controls. PTH levels decreased by 60% with niacin but rose by 41.6% in controls (P = 0.001). Potassium levels fell by 27% in the niacin group, whereas they rose by 23.9% in controls. Sodium remained stable with niacin but declined in controls. Uric acid levels rose sharply in controls but remained stable with niacin. Niacin significantly improved lipid profiles, notably reducing LDL (31.9% vs. 7.9%) and total cholesterol (13.3% vs. 3.7%). Although triglycerides and VLDL rose in both groups, these variations were not of statistical significance. Importantly, Lp(a) levels decreased by 11.4% in the niacin group.
Conclusion: Niacin (500 mg/day) offers significant cardiovascular and metabolic benefits for hemodialysis patients, supporting its role as an adjunctive therapy in managing ESRD-associated risks.
Clinical Trial Registration: https://clinicaltrials.gov/, NCT06406140.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.