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Hyperphosphatemia is a risk factor for ectopic calcification and coronary artery diseases in end stage renal diseases (ESRD). The aim of this study was to assess the effect of low-dose nicotinic acid on hyperphosphatemia in patients with ESRD. This randomized, double-blind clinical trial was done on 70 ESRD patients with serum phosphoure ≥5.5 mg/dl. Patients were randomly divided into two equal groups (n = 35) and the intervention group received niacin 25 mg/day as the initial dose. After 4 weeks, in patients who did not respond to treatment, niacin dose was increased up to 50 mg/dl. At the end of week 8, in case there was no treatment effect, the dose was raised to 100 mg/day. The appropriate response to treatment was defined as serum phosphorous level reductions <5.5 mg/dl. The age was 50.5 ± 14.3 years and duration of dialysis 5.1 ± 5.3 months. In the niacin group, mean phosphorus level decreased from 6.7 ± 0.84 mg/dl at the end of the 1st month to 5.8 ± 1.0 mg/dl at the end of the 2nd month and to 4.4 ± 1.4 mg/dl at the end of the 3rd month (P = 0.004). In the placebo group, mean phosphorus level increased from 6.5 ± 1.2 mg/dl to 7.2 ± 0.91 mg/dl at the end of the 3rd month (P = 0.006). In the niacin group, high density lipoprotein (HDL) increased significantly from 45.00 ± 14.9 to 47.2 ± 11.6 (P = 0.009). We conclude that niacin (100 mg/day) decreased phosphorus serum level and increased HDL serum level in patients on dialysis. [ABSTRACT FROM AUTHOR]

Hemodialysis has improved the morbidity and mortality associated with end stage renal disease. In India, hemodialysis prescription is empiric, which leads to complications related to under-dialysis. Hence, adequacy of hemodialysis in Indian setting was analyzed in this study. A total of 50 patients on twice per week hemodialysis were assessed for 1 month. The number of sessions meeting standards laid out by Kidney Diseases Outcome Quality Initiatives (KDOQI) guidelines were calculated. They were divided into two groups: one in whom dialysis was monitored and session length enhanced to meet the minimum standard Kt/V of 2 and second control group; where Kt/V was not monitored. Hemoglobin (Hb) levels, albumin levels, mean arterial pressure and World Health Organization (WHO) quality of life (QoL) score were compared in the two groups after 6 months. Only 28% of hemodialysis sessions were adequate as per KDOQI guidelines. There was significant improvement in Hb levels (1.47 vs. 0.15 g/dl), mean arterial pressure levels (15.2 vs. 3.16 mm Hg), serum albumin levels (0.82 vs. 0.11 g/dl) and WHO QoL score (17.2 vs. 2.24) in study group as compared to control group. Standard Kt/V can be used as an important tool to modify twice weekly dialysis sessions to provide better QoL to the patients. However, studies with larger sample size are required to conclusively prove our results. [ABSTRACT FROM AUTHOR]