Kidney Week

Abstract: SA-PO0392

Cardiovascular and Renal Outcomes of Niacin in Patients with CKD: A Causal Mediation Analysis

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Naim, Mohammad Abdullah Al Zubair, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Mohammad Abdullah Al Zubair Naim, PhD

• Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas, PhD

• Streja, Elani, University of California Irvine, Irvine, California, United States

Elani Streja, PhD, MPH

• Davis, Robert L., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Robert L. Davis

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

Niacin, a triglyceride (TG)-targeting therapy, also elevates high-density lipoprotein cholesterol (HDL-C) and may confer clinical benefits in patients with chronic kidney disease (CKD). However, evidence on the cardiovascular and renal outcomes of niacin in patients with CKD is limited. We investigated the association of de novo niacin therapy with major adverse cardiovascular events (MACE) and major adverse kidney events (MAKE). We also explored whether niacin’s effect on lipid fractions mediates these associations.

Methods

We leveraged data from the Veterans Affairs Corporate Data Warehouse and identified incident CKD patients who initiated de novo niacin (n=31,589). We used a multivariable-adjusted Cox proportional hazards model to compare the association of niacin users versus lipid-lowering therapy (LLT) non-users (n=29,500) with MACE and MAKE during follow-up of up to 5 years. Using a counterfactual causal mediation analysis, we then evaluated whether the association was mediated by lipid effects, quantified as 1-year slopes following initial exposure.

Results

Niacin use was associated with an 18% lower risk of MACE (Hazard ratio [HR], 0.82 [95% CI, 0.78, 0.86], p<0.001) and a 42% lower risk of MAKE (HR, 0.58 [95% CI, 0.56, 0.61], p<0.001). TG- and total cholesterol (TC)-lowering effects mediated 10.94% and 3.46% of the association between niacin and MACE (Table 1). TC and HDL mediated only 0.77% and 0.44% of the association with MAKE (Table 2), respectively.

Conclusion

In this large nationwide cohort of patients with CKD, de novo niacin use (vs. LLT non-use) was associated with a lower risk of MACE and MAKE. Only the TG-lowering effects substantially mediated the association with MACE, suggesting pleiotropic effects may explain the clinical benefits of niacin therapy.

Acknowledgment

This study was supported by grant I01HX002680 to Dr. Kovesdy and is the result of work supported with resources and the use of facilities at the Memphis and the Long Beach VA Medical Center. Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource Center.

Funding

• Veterans Affairs Support