PT  - JOURNAL ARTICLE
AU  - Raines, Nathan Hutzel
AU  - Ganatra, Sarju
AU  - Nissaisorakarn, Pitchaphon
AU  - Pandit, Amar
AU  - Morales, Alexander
AU  - Asnani, Aarti
AU  - Sadrolashrafi, Mehrnaz
AU  - Maheshwari, Rahul
AU  - Patel, Rushin
AU  - Bang, Vigyan
AU  - Shreyder, Katherine
AU  - Brar, Simarjeet
AU  - Singh, Amitoj
AU  - Dani, Sourbha S.
AU  - Knapp, Sarah
AU  - Poyan Mehr, Ali
AU  - Brown, Robert S.
AU  - Zeidel, Mark L.
AU  - Bhargava, Rhea
AU  - Schlondorff, Johannes
AU  - Steinman, Theodore I.
AU  - Mukamal, Kenneth J.
AU  - Parikh, Samir M.
TI  - Niacinamide may be Associated with Improved Outcomes in COVID-19-Related Acute Kidney Injury: An Observational Study
AID  - 10.34067/KID.0006452020
DP  - 2020 Jan 01
TA  - Kidney360
PG  - 10.34067/KID.0006452020
4099  - http://kidney360.asnjournals.org/content/early/2020/11/20/KID.0006452020.short
4100  - http://kidney360.asnjournals.org/content/early/2020/11/20/KID.0006452020.full
AB  - Background: Acute kidney injury (AKI) is a significant complication of Coronavirus Disease 2019 (COVID-19), with no effective therapy. Niacinamide, a vitamin B3 analog, has some evidence of efficacy in non-COVID-19-related AKI. The objective of this study is to evaluate the association between niacinamide therapy and outcomes in patients with COVID-19-related AKI. Methods: We implemented a quasi-experimental design with non-random, prospective allocation of niacinamide in 201 hospitalized adult patients, excluding those with baseline estimated glomerular filtration rate <15 ml/min/1.73m2 on or off dialysis, with COVID-19-related AKI by Kidney Disease Improving Global Outcomes (KDIGO) criteria, in two hospitals with identical COVID-19 care algorithms, one of which additionally implemented treatment with niacinamide for COVID-19-related AKI. Patients on the niacinamide protocol (B3 patients) were compared against patients at the same institution before protocol commencement and contemporaneous patients at the non-niacinamide hospital (collectively, non-B3 patients). The primary outcome was a composite of death or renal replacement therapy (RRT). Results: 38/90 B3 patients and 62/111 non-B3 patients died or received RRT. Using multivariable Cox proportional hazard modeling, niacinamide was associated with a lower risk of RRT or death (HR 0.64, 95% CI 0.40 to 1.00, p=0.05), an association driven by patients with KDIGO stage 2/3 AKI (HR 0.29, 95% CI 0.13 to 0.65, p=0.03; p interaction with KDIGO stage 0.03). Total mortality also followed this pattern (HR 0.17, 95% CI 0.05-0.52 in KDIGO 2/3 patients, p=0.002). Serum creatinine following AKI increased by 0.20 (SE 0.08) mg/dL/day among non-B3 patients with KDIGO 2/3 AKI but was stable among comparable B3 patients (+0.01 (SE 0.06) mg/dL/day; p interaction 0.03). Conclusions: Niacinamide was associated with lower risk of RRT/death and improved creatinine trajectory among patients with severe COVID-19-related AKI. Larger randomized studies are necessary to establish a causal relationship.