Tier 2 — strong

Randomized crossover clinical trial of coenzyme Q10 and nicotinamide riboside in chronic kidney disease

Armin Ahmadi, Gwenaelle Begue, Ana P Valencia, Jennifer E Norman, Benjamin Lidgard, Brian J Bennett, Matthew P Van Doren, David J Marcinek, Sili Fan, David K Prince, Jorge Gamboa, Jonathan Himmelfarb, Ian H de Boer, Bryan R Kestenbaum, Baback Roshanravan
JCI Insight 2023 8(11):e167274

Bibliography

PubMed
PMID 37159264
PubMed Central
PMC10393227
DOI
10.1172/jci.insight.167274
Funding
National Institute of Diabetes and Digestive and Kidney Diseases / NIH grants R01 DK101509, R03 DK114502 and R01 DK125794.
Competing interests
The authors declared that no conflict of interest exists.

Study snapshot

DesignRandomized, double-blind, placebo-controlled, three-treatment crossover trial with six possible treatment sequences; each six-week period separated by a one-week washout.
ModelAdults aged 30–79 with CKD, eGFR <60 mL/min/1.73 m² and 6-minute walking distance <550 m; dialysis and kidney-transplant patients excluded.
Sample25 participants; mean age 61.0 ± 11.6 years; mean eGFR 36.9 ± 9.2 mL/min/1.73 m².
InterventionCoQ10 1,200 mg/day (Tishcon), nicotinamide riboside 1,000 mg/day (Niagen), and placebo, each for six weeks in crossover sequence.
DurationThree 6-week treatment periods separated by 1-week washouts; trial conducted November 2018–April 2021.
EndpointsPrimary: VO2 peak; Primary: work efficiency during graded cycle ergometry; Total work; Submaximal VO2; eGFR; Plasma metabolomics; Plasma lipidomics

What the study showed, in plain terms

This rigorously blinded crossover study tested a very high CoQ10 dose—1,200 mg/day—for six weeks in 25 adults with moderate-to-severe CKD. Each participant also received nicotinamide riboside and placebo in separate periods, allowing within-person comparison.

CoQ10 did not improve the prespecified physical-performance outcomes: VO2 peak, total work or work efficiency were not different from placebo. eGFR was also unchanged. The trial therefore provides direct null evidence against assuming that a biochemical mitochondrial intervention automatically improves exercise capacity in CKD.

CoQ10 did alter the circulating metabolic profile, increasing free fatty acids and decreasing complex medium- and long-chain triglycerides. Those biochemical shifts are mechanistically interesting but are not equivalent to improved physical function or kidney-disease progression.

Key findings

  • VO2 peak: no significant improvement with CoQ10 versus placebo (reported p=0.17 for CoQ10 comparison).
  • Total work and total work efficiency were also null versus placebo (reported p=0.77 and p=0.55 for CoQ10 comparisons).
  • eGFR did not change with CoQ10 (reported p=0.88).
  • CoQ10 shifted lipidomics: free fatty acids increased and complex medium-/long-chain triglycerides decreased.
  • Trial registration: NCT03579693. Identical-looking tablets and blinding of participants, physicians, assessors and staff strengthened internal validity.

What this study can and cannot tell us

  • Only 25 participants, so the trial was designed for physiologic rather than hard renal or cardiovascular outcomes.
  • Each exposure lasted six weeks; longer treatment could produce different effects.
  • The study addresses exercise tolerance and circulating metabolism, not progression to dialysis, cardiovascular events or mortality.
  • The tested dose was 1,200 mg/day, far above common supplement doses, so null results should not be generalized mechanically to every dose/formulation.

Related papers in the corpus

Tier 2
A Pilot Trial of Nicotinamide Riboside and Coenzyme Q10 on Inflammation and Oxidative Stress in CKD
Ahmadi A et al. · Clinical journal of the American Society of Nephrology : CJASN · 2025

Citation network

Articles citing this research paper

2 articles

Biohack Blueprint analyses that reference this study in their evidence base.

Editorial review

Reviewed by the Biohack Blueprint research team

Last verified

Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology