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Key Points Nicotinamide adenine dinucleotide (NAD + ) is a coenzyme with roles in several cardiac and renal metabolic processes NAD + depletion is emerging as a major contributor to the pathogenesis of cardiac and renal disease Preclinical data suggest that NAD + repletion strategies have the potential to restore healthy renal and cardiac metabolism and physiology The mitochondrial sirtuins mediate some of the beneficial effects of NAD + supplementation NAD + supplementation can directly enhance metabolism and improve cellular redox reactions in the setting of cardiac and renal disease NAD + is also a substrate for enzymes involved in DNA damage repair and calcium signalling pathways
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