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Vitamin B3 may prevent AKI in patients undergoing cardiac surgery
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Recently published results showed nicotinamide, a form of vitamin B3, may help prevent AKI in patients undergoing cardiac surgery.
After finding that quinolinate phosphoribosyltransferase was a mediator of renal stress resistance in a mouse model, Samir M. Parikh, MD, and colleagues performed a nested case-control study in patients exposed to renal ischemia by on-pump cardiac surgery. Results showed higher urinary quinolinate levels among patients who developed AKI vs. patients who did not develop the condition. Researchers also found elevated urinary quinolinate/tryptophan levels shortly after the operation that persisted through postoperative day 5.
To confirm these results, researchers reviewed 215 of 329 patients in the ICU who had urine samples available before development of AKI. Results showed higher urinary quinolinate and urinary quinolinate/tryptophan levels among patients who developed AKI. Univariate analyses and multivariable models adjusted for major confounders showed an association between serial quartiles of urinary quinolinate/tryptophan with increased risk of incident AKI.
Researchers then designed a phase 1 pilot study in which patients undergoing cardiac surgery were randomly assigned to receive placebo, 1 g per day of nicotinamide or 3 g per day of nicotinamide once daily by mouth or orogastric tube. Researchers compared blood nicotinamide levels between the groups.
Results showed significantly increased blood and urine nicotinamide in patients who received nicotinamide. Researchers found increased nicotinamide mononucleotide in patients who received 3 g per day of nicotinamide, while patients who received either nicotinamide regimen experienced an increase in N1-methylnicotinamide vs. placebo. Adverse events were not associated with nicotinamide, according to results. Safety studies that combined the nicotinamide treatment groups and compared these to placebo showed patients who received nicotinamide had lower blood levels of troponin T, better estimated renal function and significantly lower AKI events.
“The results are exciting because they suggest an important new link between nutrition and kidney disease, but people with kidney disease should not start taking mega-doses of vitamin B3 today,” Parikh told Healio.com/Nephrology. “Many more studies are needed to understand how the B3 pathway works and how best to apply this knowledge for our patients.” – by Casey Tingle
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Disclosures: Parikh reports his laboratory received support by R35HL139424, R01HL125275 and R01DK095072. Please see the full study for a list of all other authors’ relevant financial disclosures.
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