Background: Dyslipidemia, a major contributing factor to cardiovascular disease, is increasingly prevalent in patients with renal disease. Low-density lipoprotein cholesterol (LDL-C) have been identified as a primary culprit of cardiovascular risk and individuals with hyperlipidemia face a significantly elevated risk of cardiovascular events. Inclisiran has shown promise in the management of dyslipidamia; however, safety and efficacy in patients with renal disease remain to be elucidated. Case 1: A 77-year-old patient with a history of ischemic heart disease and chronic kidney disease (stage V, creatinine 4.2 mg/dL; urea 110 mg/dL) was initially treated with rosuvastatin 20 mg plus ezetimibe 10 mg, with poor efficacy. Ezetimibe was subsequently discontinued due to gastrointestinal side effects. Rosuvastatin was replaced with atorvastatin 20 mg plus bempedoic acid 180 mg; however, LDL-C levels remained above 70 mg/dL. In February 2025, treatment with inclisiran 284 mg s.c. was initiated. After 3 and 12 months, he attained the LDL-C target of < 55 mg/dL. Case 2: A 69-year-old female patient with a history of ischemic stroke and chronic kidney disease (stage IV, creatinine: 2.4 mg/dL; CrCl 21 mL/min) exhibited persistently elevated LDL-C levels (>70 mg/dL) despite optimal lipid-lowering treatment with a high-intensity statin (atorvastatin 20 mg, maximal tolerated dose) plus ezetimibe 10 mg. The addition of inclisiran led to a substantial reduction in LDL-C, achieving the target of <55 mg/dL after 3 months, which was confirmed at 12 months. Conclusion: inclisiran enabled achievement of LDL-C targets in both patients after 12 months, with no reported adverse events. In the short term, inclisiran appears to be an effective and safe therapeutic option for patients with advanced renal impairment. However, long-term efficacy and safety of inclisiran in the setting of chronic kidney disease require further investigation.
Associazione Nazionale Medici Cardiologi Ospedalieri
