Niacin and related compounds for treating hyperphosphatemia in dialysis patients.

Recent experimental and clinical studies suggest the possible utility of niacin (nicotinic acid, vitamin B3) and its metabolite nicotinamide as a means of lowering phosphate levels in dialysis patients via direct inhibition of the Na-Pi-2b sodium-dependent phosphate co-transporter in the GI tract. While the possibility of taking just one or two pills a day, which do not have to be taken with meals, is very attractive, caution is warranted before moving forward with niacin and related compounds for lowering phosphate levels in dialysis patients until it is certain that they are effective, well tolerated, and safe for treatment of chronic hyperphosphatemia.