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The effect is clearest when the brain's energy system is under strain, for example during sleep deprivation, or in subjects whose dietary creatine intake is low
Metabolism, 2008
However, the evidence supporting NAD+ precursors for subjective energy levels in humans is limited and inconsistent
Patients with Renal Insufficiency For patients with mild renal insufficiency (creatinine clearance [CrCl] greater than or equal to 50 mL/min, approximately corresponding to serum creatinine levels of less than or equal to 1.7 mg/dL in men and less than or equal to 1.5 mg/dL in women), no dosage adjustment for Januvia is required
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