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Kidney Week

Abstract: PO0225

Intravenous Administration of Vitamin B Complex Improves Renal Recovery in Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Claure-Del Granado, Rolando, Hospital Obrero No 2 - CNS, Cochabamba, Bolivia, Plurinational State of
  • Torrico Salinas, Ariana, Hospital Obrero No 2 - CNS, Cochabamba, Bolivia, Plurinational State of
Background

Preclinical studies have identified NAD+ augmentation as a potential strategy for the prevention and treatment of AKI. NAD+ is the final metabolized form of vitamin B3 (niacin). Since there is no availability of niacin in the country; we tested if I.V. vitamin B complex (vitamin B1, B6 and B12) could improve renal recovery in patients with AKI. By oxidation, vitamin B6 (pyridoxine) through the pathway of pentose phosphate lead to the formation of NADPH an analog of NAD+.

Methods

We conducted randomized, blind, placebo-controlled study in hospitalized patients with AKI (NCT04893733). During the study I.V. vitamin B complex or placebo was given twice a day for 5 consecutive days. For AKI management in each patient, a protocol-based approach was used (STOP AKI protocol from the ISN 0by25 trial https://doi.org/10.1371/journal.pmed.1003408). We evaluated if vitamin B complex could improve renal recovery and if it could reduce de novo CKD incidence or CKD progression.

Results

From September 2020 to May 2021, 191 patients were enrolled in this ongoing RCT with 160 patients completing the follow-up by day 7 and 91 patients completing the follow-up by 3 months. Peak sCr was higher in patients randomized to vitamin B complex (2.8 ±1.2 vs. 2.2 ±1.3 mg/dl; p = 0.006). A higher pecentage of patients randomized to vitamin B complex arm had severe AKI (stage ≥ 2) 74% vs. 43% randomized to placebo; p = 0.011. The drop in sCr values by day 7 was higher in the vitamin B complex group (1.01 vs. 0.65 mg/dl; p < 0.001). No differences were found in the percentage of patients with complete recovery (54.3% vs. 45.6%; p=0,268), partial recovery (25.9% vs. 25.3%; p = 0.930) and non-recovery (19.8% vs. 29.1%; p = 0,168). At 3 months, the incidence of de novo CKD and CKD progression was not different in both arms (23.9% vs. 20%; p = 0.652 and 28.2% vs. 26.6%; p = 0.865 respectively). No difference was found in mortality rate at day 90 (vitamin B complex 31.1% vs. placebo 28.2%; p = 0.544).

Conclusion

The administration of vitamin B complex could potentially accelerate renal recovery in patients with AKI by day 7, reducing the percentage of patients who will not recover renal function after an AKI episode. No differences were found in terms of CKD progression or de novo CKD. The preliminary data of our ongoing study warrants future studies to validate these findings.