Dyslipidemias in Chronic Kidney Disease: Pathophysiology and Emerging Therapies

Dyslipidemia plays a critical role in the pathogenesis of both cardiovascular (CVD) and chronic kidney diseases (CKD). Although modifiable, dyslipidemia remains undertreated, probably due to the differences in management across clinical guidelines and the lack of evidence supporting treatment benefits in patients with advanced CKD and those on dialysis. High levels of lipids or changes in their structure are involved in kidney damage due to oxidative stress, inflammation, and lipotoxicity. This review explores the pathophysiology of dyslipidemia in kidney injury and the current strategies for lipid management across different CKD populations, including non-dialysis, dialysis, and kidney transplant recipients. Statins remain the first-line therapy; however, their efficacy is reduced in advanced CKD and patients on dialysis. Emerging therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, bempedoic acid, inclisiran, and icosapent ethyl, offer promising options for patients with statin intolerance or persistent dyslipidemia and have been tested in patients with CKD with a glomerular filtration rate (GFR) > 30 mL/min/m 2 . Newer targets, such as ANGPTL3, APOC3, CETP, and Lp(a), are currently being studied. Effective lipid management in patients with CKD requires a personalized, multidisciplinary approach involving nephrologists, cardiologists, endocrinologists, and primary care physicians to implement evidence-based interventions and improve long-term outcomes.