{"id":"f5e6701686fc","type":"article","url":"https://hartvaat.nl/2026/08/15/injecteerbare-lipidendalers-bij-gevorderde-chronische-nierziekte-en-dialyse-narr/","title":"Injecteerbare lipidendalers bij gevorderde chronische nierziekte en dialyse — narratieve review","title_en":"Injectable Lipid-Lowering Therapies in Advanced Chronic Kidney Disease: Efficacy, Safety and the Dialysis Paradox.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"Cardiovascular drugs and therapy","doi":"10.1007/s10557-026-07934-y","source_url":"https://doi.org/10.1007/s10557-026-07934-y","authors":["Aikaterini Damianaki","Emelina Stambolliu","Panagiotis Iliakis","Panagiotis Theofilis","Aggeliki Vakka","Evangelia Kalliakouda","Polykarpos Christos Patsalis","Dimitrios Konstantinidis","Dimitrios Petras"],"significance":6,"published":"2026-08-24","source_date":"2026-08-15","image":"https://hartvaat.nl/global/img/d869f6f0c3f9.webp","kennis":["https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This narrative review evaluates injectable lipid-lowering therapies (PCSK9 inhibitors, inclisiran, and emerging agents) in patients with advanced chronic kidney disease (CKD) and dialysis dependence. While these agents achieve substantial LDL reductions without renal toxicity, dialysis patients remain critically underrepresented in trials, contributing to divergent guidelines and the dialysis paradox. Integrating these therapies warrants serious consideration for their ability to target multiple cardiorenal risk pathways beyond LDL alone, though dedicated studies are needed to clarify their role in this high-risk population.","created":"2026-08-17T01:13:11Z","updated":"2026-08-17T01:13:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze narratieve review analyseert de rol van injecteerbare lipidendalers (PCSK9-remmers, inclisiran en opkomende middelen) bij patiënten met gevorderde chronische nierziekte (CKD) en dialyseafhankelijkheid. Hoewel deze therapieën aanzienlijke LDL-verlaging bewerkstelligen zonder nefrotoxiciteit, blijven dialysepatiënten ondervertegenwoordigd in trials, wat leidt tot tegenstrijdige richtlijnadviezen en het fenomeen van de dialyseparadox. De integratie van deze middelen verdient overweging vanwege hun potentie om niet alleen LDL, maar ook andere cardiorenale risicopaden aan te pakken, hoewel dedicated onderzoek noodzakelijk blijft.","abstract_original":"Cardiovascular (CV) disease represents the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), particularly in those with advanced stages and dialysis dependence. Dyslipidemia is highly prevalent in this population and displays distinct features, substantially affected by multiple factors such inflammation and dialysis modality. Although statins remain the cornerstone of lipid-lowering therapy in earlier CKD stages, their benefit becomes less certain in advanced disease and predominantly end-stage kidney disease. This phenomenon, termed the dialysis paradox, is further confounded by reverse epidemiology, wherein lower cholesterol paradoxically associates with worse outcomes due to malnutrition and inflammation. Injectable lipid-lowering therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (evolocumab, alirocumab), small interfering RNA (inclisiran), and emerging agents targeting ANGPTL3, apolipoprotein C-III, and lipoprotein(a), offer novel mechanisms of action with pharmacokinetic profiles largely preserved across CKD stages. Available evidence demonstrates substantial low-density lipoprotein (LDL) reduction without renal toxicity, though patients with advanced CKD and dialysis dependence remain critically underrepresented in clinical trials. Current guidelines diverge significantly for dialysis populations, reflecting this persistent evidence gap. This review synthesizes the biological rationale, pharmacologic properties, and available clinical evidence for injectable lipid-lowering therapies in advanced CKD. Moreover, it highlights why their integration into the care of this high-risk population merits serious consideration - not only for their potent and durable lipid-lowering effects, but also for their ability to target other paths that contribute to the excess CV risk not captured by LDL alone. However, key unresolved questions require dedicated investigation."}