New Agents to Reduce Cholesterol Levels: Implications for Nephrologists

Lucia Del Vecchio; Ivano Baragetti; Francesco Locatelli


Nephrol Dial Transplant. 2020;35(2):213-218. 

In This Article


CVD treatment is still an unmet need in the CKD population. PCSK9 inhibitors markedly decrease LDL-C also on top of statin therapy and reduce the risk hard endpoints in high-risk patients. At present, limited data are available for CKD since patients with advanced disease have been excluded from registration studies. Nonetheless, PCSK9 inhibitors have promising characteristics also for the CKD populations. These positive effects may be even more if associated with statin therapy. Indeed, statin therapy upregulates PCSK9, which in turn attenuates its efficacy (lower cholesterol synthesis but reduction of LDL-R recycling). Increased PCSK9 expression may then partly explain the strong reductions of LDL-C achieved with PCSK9 antibodies in patients receiving statin therapy. On the other side, PCSK9 inhibitors reduce cholesterol levels and consequently increase cholesterol biosynthesis,[67] which in turn is decreased by statin therapy. When tolerated, physicians should then consider combining statin therapy with PCSK9 inhibitors.