Clinical Trials

NR and CoQ10 Improve Kidney Function: Latest Study

A kidney disease patient study reveals nicotinamide riboside (NR) increases intermediate molecules of metabolism, and NR and coenzyme Q10 (CoQ10) both reduce harmful fats.

By Bennett M. Sherman

Key Points

  • Supplementing kidney disease patients with NR increases the abundance of molecular intermediates for cell energy generation, including ɑ-ketoglutarate.
  • Supplementing with either NR or CoQ10 diminishes levels of fats (triglycerides) circulating in blood in these patients, an indicator of improved cellular fat metabolism.

About 15% of US adults have chronic kidney disease, and as many as 90% of adults with chronic kidney disease don’t know they have it. Those with severe kidney disease often suffer from declining muscle function, precipitating frailty for some. Along those lines, researchers propose that declining mitochondrial metabolism facilitates declining physical function in these patients. As such, testing supplements that boost mitochondrial metabolism against kidney disease has become an appealing venture, with NR and CoQ10, both considered promising mitochondrial boosters, falling under the radar recently.

Published in JCI Insight, Roshanravan and colleagues from the University of California, Davis show that NR increases mitochondrial metabolism molecular intermediates in chronic kidney disease patients. Promisingly, either NR or CoQ10 reduces levels of harmful fats (triglycerides and ceramides) that inhibit cellular function in these patients. These findings suggest NR and CoQ10 can positively impact metabolism and cellular function and warrant longer studies of these molecules in kidney disease to uncover further beneficial effects.

NR Increases Metabolic Intermediates, While NR and CoQ10 Both Improve Lipid Profiles

In search of evidence showing NR or CoQ10 increases mitochondrial metabolism, Roshanravan and colleagues utilized 25 kidney disease patients with an average age of 60. The research team measured levels of molecular intermediates of mitochondrial metabolism, higher levels of which would predict metabolic improvements. The California-based team found that NR significantly increased blood levels of these molecules, including the essential metabolic metabolite ɑ-ketoglutarate. CoQ10, on the other hand, didn’t significantly increase levels of any of these intermediates of mitochondrial metabolism. These results predict that NR increases cellular energy through mitochondrial metabolism improvements in kidney disease patients.

(Ahmadi et al., 2023 | JCI Insight) NR significantly increases mitochondrial metabolism intermediates isocitrate, ɑ-ketoglutarate, and malate in chronic kidney disease patients. NR significantly increases intermediates for a mitochondrial metabolism process (TCA cycle), namely isocitrate, ɑ-ketoglutarate, and malate. NR also increases glutamate and glycerate, both protein building blocks, and 1-methylgalactose, a DNA precursor.

Kidney disease patients frequently have dysfunctional cellular beta oxidation — a process where cells utilize fatty acids for cellular energy. This leads to the buildup of harmful fats, contributing to inflammation and insulin resistance. Along those lines, CoQ10 reduced a number of fatty acids, suggesting that CoQ10 improves fatty acid usage in beta oxidation. Moreover, triglycerides, another fat form used during beta oxidation, were reduced upon CoQ10 supplementation. Supplementing with NR also reduced a number of fat molecule types, including harmful ceramides that can trigger cell death (apoptosis). These findings suggest that supplementing kidney disease patients with either CoQ10 or NR can improve their lipid profiles, a marker of improved metabolism.

“Short term CoQ10 and NR supplementation in patients with moderate-severe [chronic kidney disease] resulted in biologically plausible changes in mitochondrial metabolism and plasma lipid profile,” said Roshanravan and colleagues.

Potential Unforeseen Benefits from Combining NR and CoQ10

The study provides evidence that NR and CoQ10 improve molecular markers for improved mitochondrial metabolism, including increased metabolism intermediates and reduced triglycerides. The study failed to show whether these indicators translate to improved functional parameters, like physical function capacity, which typically deteriorates during kidney disease.

Future studies should examine whether NR or CoQ10 improves functional parameters such as insulin sensitivity in kidney disease patients. Furthermore, administering the supplements over longer periods could reveal further benefits that they provide since this study only included six weeks of administration.

Future studies could also examine whether NR and CoQ10 administered together provide synergistic effects. Along those lines, the possibility looms that when combined, the two supplements could confer benefits not seen when given on their own.

NR and CoQ10 are two over-the-counter supplements that are easy to obtain. NR costs from about $60 to $120 for a month’s supply, while a month’s worth of CoQ10 costs from about $30 to $60.

Model and Dosage

Model: Human chronic kidney disease patients with an average age of 60

Dosage: 1,000 mg per day of NR by pill for six weeks; 1,200 mg per day of CoQ10 by pill for six weeks


Ahmadi A, Begue G, Valencia AP, Norman JE, Lidgard B, Bennett BJ, Van Doren MP, Marcinek DJ, Fan S, Prince DK, Gamboa JL, Himmelfarb J, de Boer IH, Kestenbaum BR, Roshanravan B. Randomized crossover clinical trial of coenzyme Q10 and nicotinamide ribosome in chronic kidney disease. JCI Insight. 2023 May 9:e167274. doi: 10.1172/jci.insight.167274. Epub ahead of print. PMID: 37159264.

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