Tramontano Daniele, Bini Simone, Maiorca Carlo, Di Costanzo Alessia, Carosi Martina, Castellese Jacopo, Arizaj Ina, Commodari Daniela, Covino Stella, Sansone Giorgia, Minicocci Ilenia, Arca Marcello, D'Erasmo Laura
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Drugs. 2025 Mar 19. doi: 10.1007/s40265-025-02158-0.
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Quantitative and qualitative changes in plasma lipoprotein profiles are frequently associated with CKD and represent a significant risk factor for CVD in patients with CKD. Guidelines from the European Society of Cardiology and the European Atherosclerosis Society classify CKD as a condition with high or very high cardiovascular risk and set specific low-density lipoprotein cholesterol targets. Conventional lipid-lowering therapies (LLTs), such as statins, ezetimibe, and fibrates, can control CKD-associated dyslipidemia and, to some extent, prevent major atherosclerotic events in patients with CKD, but their use in clinical practice presents challenges because of the potential renal safety concerns. In recent years, novel therapies with the ability to lower both low-density lipoprotein cholesterol and triglycerides have been introduced to the market (e.g., proprotein convertase subtilisin/kexin type 9 inhibitors, bempedoic acid, lomitapide, volanesorsen) to improve our ability to control lipid abnormalities. However, their impact on kidney functionality has not been fully elucidated. The aim of this review was to examine the renal safety profiles of various LLTs, with special reference to novel medications, and to highlight important considerations and guidance for the use of these medications in overt CKD or in patients with some degree of renal function impairment. We underscore the lack of a comprehensive understanding of kidney safety, particularly for novel LLT therapies, and strongly emphasize the importance of future dedicated research to fully assess the safety and efficacy of these agents in patients with kidney abnormalities.
心血管疾病（CVD）是慢性肾脏病（CKD）患者发病和死亡的主要原因。血浆脂蛋白谱的定量和定性变化常与CKD相关，是CKD患者发生CVD的重要危险因素。欧洲心脏病学会和欧洲动脉粥样硬化学会的指南将CKD归类为心血管风险高或非常高的疾病，并设定了特定的低密度脂蛋白胆固醇目标。传统的降脂疗法（LLTs），如他汀类药物、依折麦布和贝特类药物，可以控制与CKD相关的血脂异常，并在一定程度上预防CKD患者发生主要的动脉粥样硬化事件，但由于潜在的肾脏安全性问题，它们在临床实践中的应用面临挑战。近年来，能够同时降低低密度脂蛋白胆固醇和甘油三酯的新型疗法已投放市场（如前蛋白转化酶枯草溶菌素/kexin 9型抑制剂、贝派地酸、洛美他派、volanesorsen），以提高我们控制脂质异常的能力。然而，它们对肾脏功能的影响尚未完全阐明。本综述的目的是研究各种LLTs的肾脏安全性，特别提及新型药物，并强调在显性CKD或有一定程度肾功能损害的患者中使用这些药物的重要注意事项和指导。我们强调对肾脏安全性缺乏全面的了解，特别是对于新型LLT疗法，并强烈强调未来进行专门研究以充分评估这些药物在肾脏异常患者中的安全性和有效性的重要性。
