New research suggests that taking
vitamin B-3 orally might soon become an effective way to treat or even prevent
acute kidney injury.
Ingesting vitamin B-3 may prevent
acute kidney injury.
In acute kidney
injury, the kidneys suddenly stop functioning — usually as a result
of complications during hospitalization.
Approximately 10 percent of adults who are hospitalized in the United
States reportedly develop it.
Though temporary, the condition can
be fatal. In fact, the National Institutes of Health (NIH) say that 9.5 percent of the adults who had the condition in 2013
died as a result.
Acute kidney injury occurs when
waste products accumulate in the blood and the kidneys struggle to maintain a
good balance of fluids in the body. Seniors, people already hospitalized, and
patients in intensive care units are particularly vulnerable to the condition.
New research led by Dr. Samir M.
Parikh — a kidney specialist at the Beth Israel Deaconess Medical Center
(BIDMC) in Boston, MA — suggests that a form of vitamin B-3 may be
used to prevent acute kidney injury in vulnerable people.
The findings are
now published in the journal Nature
Medicine.
Low enzyme
levels and acute kidney injury
Dr. Parikh and team studied the
metabolism of mice with acute kidney injury. Urine tests revealed lower levels
of a substance called nicotinamide adenine dinucleotide (NAD+). NAD+ is the
final metabolized form of vitamin B-3 after the vitamin has been ingested.
Also, the tests showed high levels
of another substance called quinolinate, which is a precursor of NAD+. The
researchers concluded from the findings that an enzyme that normally transforms
quinolinate into NAD+ might be malfunctioning. This enzyme is called QPRT.
In order to test their hypothesis,
the researchers used gene editing technology to create mice that had reduced
levels of the QPRT enzyme, but whose kidneys were otherwise healthy.
The mice soon started to display
symptoms of acute kidney injury, including reduced NAD+ levels and higher
levels of quinolinate.
The findings, the scientists
conclude, "established QPRT as a mediator of
renal stress resistance."
Vitamin
B-3 treatment: Safe and beneficial
Then, the researchers conducted four
human studies to examine whether quinolinate can be used to indicate reduced
NAD+ biosynthesis.
They discovered that the patients
who had undergone major surgery and were therefore prone to developing acute
kidney injury had high levels of quinolinate in their urine.
Also, the researchers administered
large doses of vitamin B-3 to 41 people who had undergone cardiac surgery.
"Our
results," explains study co-author Dr. Kamal Khabbaz, the chief of cardiac
surgery at the CardioVascular Institute at the BIDMC, "suggest that NAD+
biosynthesis becomes impaired during human acute kidney injury and that
augmenting vitamin B-3 levels may be safe and potentially beneficial to
patients."
"What's more," continues
Dr. Khabbaz, "we showed that urinary measurements in at-risk patients can
indicate this impairment and, furthermore, predict adverse outcomes."
"Restoring NAD+ could
constitute an important advance for patients at risk for acute kidney injury,
though further studies are needed to verify these findings," concludes Dr.
Khabbaz.
Dr. Parikh echoes the same caution,
saying, "These findings are very early, but the results suggest that we
could one day have a non-invasive test for NAD+ status and perhaps even treat
acute kidney injury by boosting NAD+ levels."
"We were able to detect a drop
in NAD+ in the urine of high-risk patients who were either in an intensive care
unit or undergoing a major surgery and found that oral vitamin B-3 could safely
elevate NAD+ in high-risk patients."
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