Niacin and Chronic Kidney Disease
Niacin and Chronic Kidney Disease
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DOI：
10.3177/jnsv.61.s173
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发表时间：
2015-05-01
影响因子：
1.6
通讯作者：
Yamamoto, Hironori
中科院分区：
文献类型：
--
作者：
Taketani, Yutaka;Masuda, Masashi;Yamamoto, Hironori
慢性肾脏病（CKD）是一个日益严重的问题在世界范围内。在日本，需要透析治疗的终末期肾病患者数量估计每年增加10，000例。此外，日本估计有1300万人患有CKD。各种并发症与CKD相关，包括心血管疾病（CVD）。超过三分之一的CKD患者死于CVD。因此，CVD的预防是CKD患者治疗的主要关注点。CKD-矿物质和骨骼疾病（CKD-MBD）是一种严重的并发症，通常会导致CVD。高磷血症被认为是CKD-MBD的中心风险因素。因此，控制高磷血症对于预防CKD-MBD和CVD至关重要。高磷血症患者仅通过饮食调整难以达到目标血磷水平，因为大多数食物都含有磷酸盐。因此，磷酸盐结合剂（如碳酸钙）通常用于患有高磷酸盐血症的CKD患者，但这些药物具有不良副作用。还研究了抑制肠道磷酸盐转运活性作为控制CKD患者血清磷酸盐水平的替代方法。烟酰胺是烟酸的酰胺，可抑制肠道磷酸盐转运。烟酸和相关化合物也已被开发为用于高脂血症病症，特别是具有低高密度脂蛋白的高脂血症的药物。这种类型的血脂异常在CKD患者中经常观察到，并且是CVD的可改变的风险因素。因此，烟酸和相关化合物可用于治疗CKD患者的高磷酸盐血症和血脂异常以预防CVD。
Chronic kidney disease (CKD) is an increasing problem worldwide. The number of end-stage renal disease patients requiring treatment by dialysis is estimated to be increasing by 10,000 patients per year in Japan. Furthermore, an estimated 13 million people are living with CKD in Japan. Various complications are associated with CKD, including cardiovascular disease (CVD). More than one-third of CKD patients die from CVD. Thus, prevention of CVD is a primary concern for the treatment of CKD patients. CKD-mineral and bone disorder (CKD-MBD) is a serious complication that typically leads to CVD. Hyperphosphatemia is thought to be a central-risk factor for CKD-MBD. Therefore, managing hyperphosphatemia is crucial to prevent CKD-MBD and CVD. It is difficult to achieve the target serum phosphate level through dietary modifications alone in patients with hyperphosphatemia, because most foods contain phosphate. Thus, phosphate binders such as calcium carbonate are commonly prescribed to CKD patients with hyperphosphatemia, but these have undesirable side effects. Inhibition of intestinal phosphate transport activity has also been investigated as an alternative approach for controlling serum phosphate levels in CKD patients. Nicotinamide, which is the amide of niacin, can inhibit intestinal phosphate transport. Niacin and related compounds have also been developed as drugs for hyperlipidemia conditions, especially hypertriglyceridemia with low high-density lipoprotein. This type of dyslipidemia is frequently observed in CKD patients and is a modifiable risk factor for CVD. Thus, niacin and related compounds may have utility for the treatment of both hyperphosphatemia and dyslipidemia in CKD patients to prevent CVD.