A chance observation that serum phosphate levels declined in patients on hemodialysis treated with niceritrol, a pro-drug for niacin, led to the discovery that extended-release niacin could decrease elevated serum phosphate in patients with CKD, to a marked degree; indeed, in the first such study, one to two tablets of extended-release niacin daily (325 mg/tablet), taken with meals, were reported to reduce serum phosphate from 7.7 mg/L at baseline (treatment with phosphate binders had been dis- continued 1 wk earlier) to 5.6 mg/L after 8 wk [174–177]. More recent studies, targeting patients with MetS and/or type 2 diabetes, but normal kidney function, found that 2 g daily of extended-release niacin, taken once daily with meals, with or without concurrent laropiprant, lowered fasting serum phos- phate significantly by about 10% relative to placebo-treated controls [178–180].