Antiproteinuric effect of niceritrol, a nicotinic acid derivative, in chronic renal disease with hyperlipidemia: a randomized trial

Purpose Lipoprotein (a) [Lp(a)] levels increase in patients with renal disease. We administered niceritrol, a nicotinic acid derivative, to patients with chronic renal disease and a high serum Lp(a) level, and studied its effects on lipid metabolism, proteinuria, and renal function. Methods Thirty-three patients with chronic renal disease whose serum Lp(a) levels were ≥15 mg/dL were randomly (but not blindly) assigned to treatment with niceritrol (n = 16) or to an untreated control group (n = 17). Parameters of lipid metabolism, excretion of urinary protein, and renal function were examined for 12 months. Results Changes in urinary protein excretion, as well as Lp(a) levels, differed significantly between the two groups. The mean (± SD) change from baseline in excretion of urinary protein was 0.77 ± 1.23 g/d in the control group compared with −1.41 ± 2.26 g/d in the niceritrol group at 12 months (P = 0.003). Mean Lp(a) levels increased by 3 ± 10 mg/dL in the control group compared with a decrease of 10 ± 13 mg/dL in the niceritrol group at 12 months (P =0.004). The mean creatinine clearance declined by 10 ± 12 mL/min in the control group, compared with 1 ± 13 mL/min in the niceritrol group at 12 months (P =0.06). Conclusion Lipid levels improved with niceritrol treatment, whereas the excretion of urinary protein decreased, perhaps slowing the rate of loss of renal function in chronic renal disease.