Kidney Week

Abstract: SA-OR04

Niacinamide and Renal Recovery After AKI: A Randomized, Controlled Trial

Session Information

• AKI Research: Seeking New Paths to Progress
  November 04, 2023 | Location: Room 118, Pennsylvania Convention Center
  Abstract Time: 04:57 PM - 05:06 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Kohli, Harbir Singh, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

Harbir Singh Kohli, MD

• Garg, Sahil, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

Sahil Garg,

• Kaur, Jaskiran, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

Jaskiran Kaur,

• Yadav, Ashok Kumar, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

Ashok Kumar Yadav,

• Kumar, Vivek, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

Vivek Kumar,

Background

Incomplete recovery following community acquired acute kidney injury CA-AKI may be seen in 15-20% of patients. Strategies to improve recovery rates and follow-up of such patients are required. The impaired NAD+ biosynthesis pathway has been recently implicated in AKI. Niacinamide, which bypasses the salvage denovo pathway and produces NAD, could be protective. Its role in recovery following AKI has been postulated. In this pilot phase of clinical trial, role of niacinamide supplementation in recovery after CA-AK was investigated .

Methods

The study was an open label, randomized, controlled trial. Patients of CA-AK aged 18-70 years were enrolled. Underlying CKD,urinary tract obstruction, malignancy, heart failure, pregnancy, lactating women or poor performance status were excluded. Participants were randomized to receive either niacinamide (500 mg BD for 14 days) or no intervention. Follow-up visits were at 1and 4 months after hospital discharge. The primary outcome was difference in renal recovery at 4 months after discharge. Renal recovery was defined as eGFR ≥60 ml/min/1.73m² at 4 months after hospital discharge. Secondary outcome measures were differences in eGFR between groups at 1 and 4 months after hospital discharge.Trial was prospectively registered (CTRI/2022/03/040892).

Results

Over a period of 6 months starting June 2022, 89 patients were screened. 50 patients were enrolled and randomized . Infections (70%), toxic envenomations (8%), rhabdomyolysis (8%) and drug induced AKI (6%) were leading causes. Majority (49 of 50) had stage 3 AKI with 32 (64%) requiring kidney replacement therapy. 6 patients expired and one patient did not report for follow up. Finally 43 patients were analyzed for outcome measures. The clinical characteristics: age,sex, DM,HT, AKI stage, were similar between groups at baseline. Renal recovery at 4 months was significantly higher in the niacinamide group (20/21, 95.2%) as compared to the controls (15/22, 68.18% p0.023). eGFR (ml/my/1.73m²) at 1 month (99.9+27.9 vs 71.9+33.3 p0.040) and 4 months (108.2+26.2 vs 77.7+31.3 p0.001) after hospital discharge were also significantly higher in the intervention group as compared to control group. No major drug-related adverse events were recorded.

Conclusion

Niacinamide supplementation improved renal recovery at 4 months after hospital discharge in patients with severe AKI.

Funding

• Government Support – Non-U.S.