Kidney Week

Abstract: SA-PO0440

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors Significantly Reduce Hypercholesterolemia in Patients on Dialysis

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Abinti, Matteo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Matteo Abinti, MD

• Tripodi, Federica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Federica Tripodi

• Binda, Valentina, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Valentina Binda, MD

• Bari, Federico, Azienda Sanitaria Territoriale Pesaro Urbino, Urbino, Marche, Italy

Federico Bari, MD

• Samele, Gianluca, Azienda Sanitaria Territoriale Pesaro Urbino, Urbino, Marche, Italy

Gianluca Samele

• Samoni, Sara, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Sara Samoni, MD

• Zanoni, Francesca, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Francesca Zanoni, MD

• Porata, Giulia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Giulia Porata, MD

• Vettoretti, Simone, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Simone Vettoretti

• Di luca, Marina, Azienda Sanitaria Territoriale Pesaro Urbino, Urbino, Marche, Italy

Marina Di luca, MD

• Castellano, Giuseppe, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy

Giuseppe Castellano, MD, PhD

Background

Hypercholesterolemia is highly prevalent among patients (pts) undergoing dialysis, representing a major contributor to cardiovascular (CV) mortality.Conventional lipid lowering strategies often show limited efficacy and drug intolerance.PCSK9i have recently emerged as a strong lipid-modifying agents capable of reducing LDL and total cholesterol levels.However, evidence regarding their efficacy and safety in dialysis is scarce.

Methods

We retrospectively evaluated clinical data from a real-world cohort of 21 dialysis pts routinely followed at the Nephrology of Policlinico di Milano and AST Pesaro-Urbino, who initiated therapy with PCSK9i (16 with Evolocumab and 5 Inclisiran).16 pts were undergoing haemodialysis, 5 peritoneal dialysis.Comorbidities, lipid profile, drug safety and CV outcomes were evaluated.

Results

Mean age was 65 years, 72% males, mean dialysis vintage 4 years.8 pts had a history of CV events, 17 a diagnosis of PAD.In 7 pts, PCSK9i were initiated due to statin intolerance (CPK elevation), while in 14 pts were added to statins/ezetimibe because of inadequate cholesterol control.Median follow-up (FU) was 8±3 months.Following PCSK9i initiation, a rapid and significant improvement in lipid parameters was observed (Figure 1).After 3 months, total cholesterol levels were reduced by 40%, and LDL by 50%.These effects were sustained over time, 36% in total cholesterol and 40% in LDL at 6 months.2 patients had 1 year of FU.No significant reduction in triglyceride levels was observed (<10%).Lipid-lowering efficacy was comparable between HD and PD pts (p=0.9).No adverse events, therapy discontinuation or CV events occurred during FU. 1 pt died after 7 months, because of a metastatic cancer; 1 was excluded after 4 months, due to kidney transplantation.

Conclusion

In this small dialytic cohort, PCSK9i were well tolerated and associated with a rapid, marked, and sustained reduction in total and LDL cholesterol levels.Larger prospective studies are warranted to confirm long-term safety and CV benefits in this high-risk population.