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There have been postmarketing reports of acute renal failure (unspecified) and worsening of chronic renal failure, which sometimes has required hemodialysis in patients treated with GLP-1 receptor agonists

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240 Furthermore, the expression of enzymes in the NAD + salvage pathway, including Nmrk1, Nampt, and Nadk, has circadian oscillation patterns in WT and Liver-RE mice that exclusively express BMAL1 in the liver, suggesting the circadian clock might reprogram NAD + salvage synthesis to maintain the fluctuation of NAD +

That said, most clinical trials have studied the effects of astaxanthin at a dose range between 1 and 40 mg