The Generalized Association Between Niacin Intake and Cardiovascular Events in US Adults Living With Chronic Kidney Disease

Background: The effects of dietary niacin on the risk of cardiovascular disease (CVD) and mortality in patients with chronic kidney disease (CKD) remain unclear. Methods: CKD patients with estimated glomerular filtration rates (eGFRs) 20–59 mL/min/1.73 m2 or urinary albumin/creatinine ratio ≥30 mg/g were identified in the National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2018. Age, gender, race, education level, marital status, body mass index, blood pressure, and smoking and drinking history were considered as confounders. Results: The present study encompassed 3815 CKD patients eligible for inclusion based on the study criteria. Participants with a niacin intake of >27.7 mg/d (quartile 4) had a lower prevalent CVD risk than those with an intake of ≤14.67 mg (quartile 1) (odds ratio (OR), 0.710, 95% CI: 0.560–0.900; p for trend = 0.004). In the follow-up with a median of 7.0 years, 323 from CVD. After adjustment, a higher niacin intake (>27.7 mg) reduced CVD mortality compared to a lower intake (≤14.67 mg) (hazard ratio (HR), 0.610, 95% CI: 0.480–0.770; p for trend <0.001). Adding dietary niacin to clinical variables increased the C-index from 0.746 to 0.749 for CVD prevalence and from 0.659 to 0.682 for mortality. The net reclassification improvement increased by 9.0% and 13.1% for CVD and mortality, respectively, and the integrated discrimination improvement increased by 0.3% and 1%, respectively. Conclusions: Higher dietary niacin intake may reduce CVD and its mortality in individuals with CKD.