Key Points
Research suggests niacin may influence phosphorus levels and cholesterol in kidney disease - but may have serious side effects.
Studies indicate niacin might reduce phosphorus absorption in the gut, with varying effects on kidney function.
Evidence shows niacin can increase HDL cholesterol, but its impact on heart health in CKD patients is mixed.
Some studies raise concerns about risks with niacin, so careful consideration with a naturopath is essential.
Introduction to Niacin and Kidney Disease
Niacin, also known as vitamin B3, plays a role in energy production and metabolism. If you’re managing chronic kidney disease (CKD), you’re likely focused on controlling phosphorus, supporting kidney function, and balancing cholesterol. At our naturopathic clinic, we’re exploring what research says about niacin’s potential in these areas. Let’s look at the findings and why talking to a naturopath about it matters.
Role in Phosphorus and Kidney Function
High phosphorus levels can be a challenge in CKD, contributing to bone and heart issues. Some studies suggest niacin or its form, niacinamide, might lower blood phosphorus by reducing how much your gut absorbs. A study from 2012 found it lowered phosphorus levels in dialysis patients, and another from 2009 reported similar findings.
However, randomized trials examining niacin have demonstrated limited efficacy, poor tolerance, and some safety concerns. For example, in a randomized trial that included over 700 patients on hemodialysis who were using nicotinamide had lowered phosphate levels compared with placebo at 24 weeks, but this effect was not maintained at 52 weeks of follow-up. There were also higher rates of side effects.
When it comes to kidney function—like slowing CKD progression—the picture is not clear. A 2025 study found niacin use was associated with higher risk of developing kidney disease - but then a slower rate of kidney disease progression once it is established. These results are confusing and murky - at best.
Niacin Improved Cholesterol but May Shorten Lifespan
CKD often brings cholesterol imbalances that can increase heart risks. Studies show niacin can raise HDL (good cholesterol) and lower triglycerides. However, a large study from 2015 found that despite these changes, CKD patients didn’t see fewer heart problems, and some risks even went up. So, while lab numbers shift, the real benefit for your heart and overall health may not improve. By the end of the study the niacin-group had more heart problems and fewer patients surviving compared to the placebo group. At the end of the day - the overall survival rate of patients - tends to trump other outcomes in kidney disease. It is not helpful to improve cholesterol or kidney function if it does not lead to patients living longer healthier lives.
Safety and Next Steps
Niacin isn’t without its challenges. It has been found to also be associated with liver issues, higher blood sugar, and other concerns. With mixed study results—including some showing increased risks—it’s critical to talk to a naturopath to discuss whether there might be better alternatives available.
