RT Journal Article
SR Electronic
T1 Niacinamide may be Associated with Improved Outcomes in COVID-19-Related Acute Kidney Injury: An Observational Study
JF Kidney360
JO Kidney360
FD American Society of Nephrology
SP 10.34067/KID.0006452020
DO 10.34067/KID.0006452020
A1 Raines, Nathan Hutzel
A1 Ganatra, Sarju
A1 Nissaisorakarn, Pitchaphon
A1 Pandit, Amar
A1 Morales, Alexander
A1 Asnani, Aarti
A1 Sadrolashrafi, Mehrnaz
A1 Maheshwari, Rahul
A1 Patel, Rushin
A1 Bang, Vigyan
A1 Shreyder, Katherine
A1 Brar, Simarjeet
A1 Singh, Amitoj
A1 Dani, Sourbha S.
A1 Knapp, Sarah
A1 Poyan Mehr, Ali
A1 Brown, Robert S.
A1 Zeidel, Mark L.
A1 Bhargava, Rhea
A1 Schlondorff, Johannes
A1 Steinman, Theodore I.
A1 Mukamal, Kenneth J.
A1 Parikh, Samir M.
YR 2020
UL http://kidney360.asnjournals.org/content/early/2020/11/20/KID.0006452020.abstract
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.