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.