Objective: Chronic kidney disease (CKD) places patients in the high cardiovascular risk category, often requiring low LDL-cholesterol (LDL-C) levels achievable with PCSK9 inhibitors. Long-term real-world data on kidney function under proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition are limited. Design and method: We analysed consecutive patients with hypercholesterolaemia attending a tertiary lipid clinic who initiated evolocumab or alirocumab and were followed for up to 5 years. An age- and sex-matched general population cohort served as comparator. Clinical and laboratory data were collected at baseline and after 5 years. Glomerular Filtration Rate (GFR) was estimated using CKD-EPI (primary), MDRD, Cockcroft–Gault and Mayo Quadratic equations, and their mean. Changes in continuous variables were assessed with paired or unpaired tests, as appropriate. Linear regression models with visit number as a continuous predictor were used to estimate eGFR slopes and p for trend. Results: The PCSK9 inhibitor cohort included 258 patients (54.7% men; 74% evolocumab, 26% alirocumab) and the control cohort 325 subjects. Despite a higher baseline cardiovascular risk, PCSK9-treated patients showed only a modest decline in eGFR over 5 years, with mean values remaining in the mildly impaired range and no evidence of abrupt deterioration after treatment initiation. eGFR class remained stable in PCSK9-treated patients, whereas the control cohort tended to shift towards lower eGFR categories. LDL-C and atherogenic lipids improved substantially only in the PCSK9 group. Conclusions: In high cardiovascular risk patients, long-term PCSK9 inhibitor therapy is associated with preserved kidney function compared with a general population cohort, supporting the renal safety of LDL-C lowering in routine clinical practice.
Borghi et al. (Fri,) studied this question.