At a family dinner, a relative with stage 3 chronic kidney disease mentions getting winded on the stairs and running out of energy by mid-afternoon. A sibling suggests an NAD+ booster, one of the supplements sold with promises to “recharge” tired cells. The fair questions are whether it would help, and whether it is safe with weakened kidneys.
The most direct evidence is a small placebo-controlled trial of nicotinamide riboside (NR), a common NAD+ precursor, in 25 adults with moderate-to-severe kidney disease. After six weeks, NR did not improve peak exercise capacity or work efficiency on a stationary bike, and kidney function held steady. Blood chemistry did shift, which is why the researchers want longer studies. Separately, larger trials of nicotinamide, a related form of vitamin B3, in kidney patients turned up side effects worth knowing about.
What the six-week kidney trial measured
NAD+ is a molecule that mitochondria, the energy-producing parts of cells, rely on to turn food into fuel. Faltering mitochondria may help explain why people with chronic kidney disease often tolerate exercise poorly, so researchers from the University of Washington and UC Davis tested NR alongside coenzyme Q10 (CoQ10), another supplement linked to mitochondrial energy.
They enrolled 25 people with an eGFR below 60, averaging about 37, at a mean age of 61. Each took NR, CoQ10 and a placebo in random order for six weeks apiece, with a one-week break between phases, and neither participants nor staff knew which capsule was which. The trial ran from 2018 to 2021 with National Institutes of Health grant funding and is registered as NCT03579693.
Neither supplement improved peak oxygen use in a cycling test, a standard fitness measure, or work efficiency compared with placebo. NR lowered the oxygen used at a light 30-watt stage, a secondary efficiency hint. It also changed blood levels of energy-cycle chemicals and lowered fats such as triglycerides and ceramides. All 25 finished, with no serious adverse effects; side effect reports numbered six during NR, three during CoQ10 and four during placebo.
A 2025 paper from the same trial found that NR raised one immune signal, IL-2, that both supplements lowered F2-isoprostanes, a marker of oxidative damage, and that NR improved an energy score in a type of white blood cell. These are marker changes. None shows that a person feels less tired or that the kidneys last longer.
What nicotinamide trials in kidney patients add
Nicotinamide is another vitamin B3 compound the body can use to build NAD+. Kidney specialists tested it in larger, longer trials to lower high blood phosphate. In the year-long COMBINE trial of 205 people with stage 3b or 4 kidney disease, nicotinamide did not lower phosphate or the hormone FGF23, and stomach and bowel symptoms made the pills hard to keep taking.
In people on dialysis, results were more mixed. The NICOREN study compared nicotinamide with the phosphate binder sevelamer in 100 patients. Phosphate fell in both groups, but only 55% of the nicotinamide group completed the study versus 90% on sevelamer, and four nicotinamide patients developed low platelet counts. The larger NOPHOS trial added a modified-release nicotinamide to usual treatment in more than 700 dialysis patients. Phosphate was lower at 24 weeks, but the gap did not hold at one year, and the drug was linked to more low platelets, itching, anemia and diarrhea. Shingles occurred only in the nicotinamide group.
Nicotinamide is not the same compound as NR, and it was given as a monitored medicine. Still, “it’s just a vitamin” did not mean an easy ride for kidney patients.
What is still being tested, and what to ask the kidney team
A phase 2 trial is testing a pharmaceutical-grade form of NMN, another NAD+ precursor, in 156 adults with diabetic kidney disease, with protein in the urine as the main outcome. As of its last registry update in April 2026, it was still recruiting, with primary completion expected in November 2026 and no results posted.
Each of these trials gave participants capsules or tablets produced for clinical study, with doctors watching. No trial tested the NAD+ products listed online as research chemicals, and those are not intended for human use.
The National Kidney Foundation advises people with kidney disease to check with their healthcare team before starting herbal supplements, since some leave the body through the kidneys and can build up; the same caution fits NAD+ boosters. For the relative who gets winded on the stairs, the more useful step is to raise the tiredness itself with the kidney team. The NIDDK notes that anemia, a common complication of kidney disease, can cause fatigue and shortness of breath. The supplement question can go on the list for that visit.
Sources
- Ahmadi A et al. Randomized crossover clinical trial of coenzyme Q10 and nicotinamide riboside in chronic kidney disease. JCI Insight, 2023 (PubMed)
- Ahmadi A et al. A pilot trial of nicotinamide riboside and coenzyme Q10 on inflammation and oxidative stress in CKD. Clin J Am Soc Nephrol, 2025 (PubMed)
- ClinicalTrials.gov NCT03579693: Trial of nicotinamide riboside and co-enzyme Q10 in chronic kidney disease
- Ix JH et al. Effects of nicotinamide and lanthanum carbonate on serum phosphate and FGF23 in CKD: the COMBINE trial. J Am Soc Nephrol, 2019 (PubMed)
- Lenglet A et al. Efficacy and safety of nicotinamide in haemodialysis patients: the NICOREN study. Nephrol Dial Transplant, 2017 (PubMed)
- Ketteler M et al. Modified-release nicotinamide for hyperphosphataemia in haemodialysis patients: 52-week results of the NOPHOS trial. Nephrol Dial Transplant, 2023 (PubMed)
- Chandra MS et al. Nicotinamide adenine dinucleotide augmentation in diabetic kidney disease: randomized trial study protocol. Kidney Int Rep, 2026 (PubMed)
- ClinicalTrials.gov NCT05759468: NAD augmentation in diabetes kidney disease
- National Kidney Foundation: Herbal supplements and kidney disease
- NIDDK: Anemia in chronic kidney disease
Related reading
- Can an NAD+ Booster Help a Weak Heart? A Small Placebo Trial Checked
- Walking for Blood Pressure? Adding Nicotinamide Riboside Did Not Help More
- Prediabetes and NAD+ Boosters: Did NMN or NR Lower Blood Sugar?
By The Everyday Brief. AI-assisted drafting with automated source and editorial checks. Sources fetched 2026-10-25 PT. Not medical advice.