Nicotinamide Riboside Supplementation in Chronic Kidney Disease (NR-CKD)

Pilot Randomized Crossover Trial of Nicotinamide Riboside in Chronic Kidney Disease (NR-CKD Trial)

This study is testing whether a dietary supplement called nicotinamide riboside, (NR), can be used in adults with moderate chronic kidney disease. NR is a form of vitamin B3 that may help support cellular energy metabolism.

The main goal of this study is to see whether it is feasible for people with chronic kidney disease to take NR daily, complete study visits, and follow the study procedures. The study will also explore whether NR chloride affects markers of mitochondrial health, small blood vessel function, and physical function.

Participants will be randomly assigned to one of two treatment orders. One group will take NR first and placebo second. The other group will take placebo first and NR second. Placebo looks like NR but does not contain active NR. Each treatment period lasts 12 weeks, with an approximately 2-week washout period between treatments. Neither participants nor the study team will know which treatment participants are taking during each period.

Study visits will include blood and urine collection, physical function testing, and noninvasive tests of small blood vessel function. The study will enroll up to 36 adults with moderate chronic kidney disease at the University of California, San Diego.

Study Overview

• Status: Not yet recruiting
• Conditions: Chronic Kidney Disease
• Intervention / Treatment: Dietary supplement: Matched Placebo (Capsules); Dietary supplement: Nicotinamide Riboside (NR)

Detailed Description

Chronic kidney disease is associated with impaired mitochondrial function, vascular dysfunction, reduced physical function, and increased risk of cardiovascular and functional decline. Nicotinamide riboside is a vitamin B3 derivative and NAD+ precursor that may support cellular energy metabolism and vascular health.

This pilot study will evaluate the feasibility of using nicotinamide riboside in adults with moderate chronic kidney disease. The study uses a randomized, double-blind, placebo-controlled crossover design so that each participant receives both nicotinamide riboside chloride and placebo during separate treatment periods.

In addition to feasibility measures, the study will collect exploratory data on mitochondrial, microvascular, and physical function outcomes. These data will help determine whether a larger clinical trial of nicotinamide riboside in chronic kidney disease is practical and scientifically justified.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Armin Ahmadi, PhD; Phone Number: 619-543-6248; Email: a3ahmadi@ucsd.edu

Study Locations

• United States
  • California
    • San Diego, California, United States, 92093
      • Altman Clinical and Translation Research Institute
      • Contact: Armin Ahmadi, PhD; Phone Number: (619) 543-6248; Email: a3ahmadi@ucsd.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Moderate chronic kidney disease not treated with dialysis, defined as eGFR 30-59 mL/min/1.73 m2 using the CKD-EPI equation.
• Urine albumin-to-creatinine ratio (uACR) <300 mg/g.
• Able to provide informed consent.
• Able to walk unassisted from room to room, with usual assistive device allowed if approved by study safety assessment.
• Willing and able to comply with study procedures, visits, and study product administration.

Exclusion Criteria:

• Pregnancy.
• Expectation to start dialysis within 6 months.
• Unable to walk unassisted from room to room.
• Institutionalization or inability to consent.
• End-stage liver disease with cirrhosis.
• HIV.
• Oxygen-dependent COPD.
• Baseline systolic blood pressure >170 mmHg or diastolic blood pressure >100 mmHg.
• Current participation in another interventional trial.
• Use of immunosuppressive medications, including steroids or calcineurin inhibitors.
• Malignancy requiring active treatment or currently under surveillance at the discretion of the investigator.
• Hospitalization for myocardial infarction, unstable angina, cerebrovascular accident, or unstable cardiac chest pain within the prior 3 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Placebo Then NR; Participants assigned to this arm will receive matched placebo for 12 weeks, followed by an approximately 14-day washout/crossover period, then nicotinamide riboside 1000 mg/day for 12 weeks.	Dietary supplement: Matched Placebo (Capsules); Matched placebo will be administered orally for 12 weeks during the placebo treatment period. The placebo will be identical or substantially similar in appearance to the active nicotinamide riboside study product to maintain blinding.
Experimental: NR Then Placebo; Participants assigned to this arm will receive nicotinamide riboside 1000 mg/day for 12 weeks, followed by an approximately 14-day washout/crossover period, then matched placebo for 12 weeks.	Dietary supplement: Nicotinamide Riboside (NR); Nicotinamide riboside will be administered orally at a target dose of 1000 mg/day for 12 weeks during the active treatment period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recruitment Rate	Percentage of eligible approached participants who consent and are randomized.	From study opening to completion of enrollment, up to 18 months
Retention Rate	Percentage of randomized participants who complete both treatment periods and the Week 26 final study visit.	Through the end of the study period; Week 26
Study Product Adherence	Adherence will be assessed using study product dispensing and return records, pill count or participant-reported remaining product, and monthly adherence calls. Adherence success is defined as taking at least 75% of prescribed doses during a treatment period.	Weeks 12 and 26

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in plasma cell-free mitochondrial DNA	Change in plasma cell-free mitochondrial DNA concentration, measured as mitochondrial DNA copies per mL of plasma using droplet digital PCR.	Baseline, Week 12, and Week 26
Change in urine cell-free mitochondrial DNA	Change in urine cell-free mitochondrial DNA concentration, measured using droplet digital PCR and reported as mitochondrial DNA copies normalized to urine osmolarity.	Baseline, Week 12, and Week 26
Change in skin fingernail capillary density	Change in skin capillary density, measured as capillaries per mm2 using capillaroscopy.	Baseline, Week 12, and Week 26
Change in skin blood flow	Change in skin blood flow, measured in laser Doppler perfusion units using laser Doppler flowmetry.	Baseline, Week 12, and Week 26
Change in six-minute walk distance	Change in distance walked during the six-minute walk test, measured in meters.	Baseline, Week 12, and Week 26
Change in Handgrip Strength	Change in handgrip strength, measured in kilograms using handheld dynamometry.	Baseline, Week 12, and Week 26
Change in Timed Up and Go	Change in Timed Up and Go test performance, measured in seconds.	Baseline, Week 12, and Week 26
Change in 30-second sit-to-stand	Change in the number of chair stands completed during the 30-second sit-to-stand test, measured as repetitions completed in 30 seconds.	Baseline, Week 12, and Week 26

Collaborators and Investigators

• Sponsor: University of California, San Diego
• Investigators: Principal Investigator: Armin Ahmadi, PhD, University of California, San Diego

Publications and helpful links

General Publications

• Trammell SA, Schmidt MS, Weidemann BJ, Redpath P, Jaksch F, Dellinger RW, Li Z, Abel ED, Migaud ME, Brenner C. Nicotinamide riboside is uniquely and orally bioavailable in mice and humans. Nat Commun. 2016 Oct 10;7:12948. doi: 10.1038/ncomms12948.
• Martens CR, Denman BA, Mazzo MR, Armstrong ML, Reisdorph N, McQueen MB, Chonchol M, Seals DR. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018 Mar 29;9(1):1286. doi: 10.1038/s41467-018-03421-7.
• Conze D, Brenner C, Kruger CL. Safety and Metabolism of Long-term Administration of NIAGEN (Nicotinamide Riboside Chloride) in a Randomized, Double-Blind, Placebo-controlled Clinical Trial of Healthy Overweight Adults. Sci Rep. 2019 Jul 5;9(1):9772. doi: 10.1038/s41598-019-46120-z.

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): September 30, 2028
• Study Completion (Estimated): September 30, 2028

Study Registration Dates

• First Submitted: June 29, 2026
• First Submitted That Met QC Criteria: July 3, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 3, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Chronic kidney disease; Physical function; Microvascular function; Nicotinamide riboside; Cell-free mitochondrial DNA
• Additional Relevant MeSH Terms: Urogenital Diseases; Pathologic Processes; Male Urogenital Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Chronic Disease; Disease Attributes; Renal Insufficiency; Pathological Conditions, Signs and Symptoms; Renal Insufficiency, Chronic; Pharmaceutical Preparations; Dosage Forms; Capsules; nicotinamide-beta-riboside
• Other Study ID Numbers: UCSD-NR-001; 1K01DK147652 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No