Inclisiran in Chronic Kidney Disease Patients: A Real-World Experience

Patients with chronic kidney disease (CKD) have a high incidence of morbidity and mortality from cardiovascular causes. Among the most significant cardiovascular risk factors is undoubtedly hypercholesterolemia, especially elevated cholesterol LDL levels. The first-line therapy for the management of hypercholesterolemia, including in patients with CKD, is represented by statins even in combination with ezetimibe. In patients with CKD, statin therapy is often poorly tolerated with high incidence of rhabdomyolysis. An alternative treatment is represented by small interfering RNA inclisiran, which has been shown to be effective in double yearly administration.

Thirty-two patients (19 males and 13 females) with a mean age of 60.2 years, basal total cholesterol values of 225 mg/dL and LDL cholesterol values of 138 mg/dL were enrolled in our observational study. The mean eGFR value at baseline was 36.93 mL/min/m2. All patients had a diagnosis of chronic ischemic heart disease (CAD), and 4 patients also had type 2 diabetes mellitus. The patients received therapy with inclisiran 284 mg at time zero, then repeated at 3 months and then at 6 months.

After 12 months of treatment, there was almost 50% reduction in both total and LDL cholesterol values with no significant change in eGFR values. Only one patient presented with an episode of myocardial infarction 11 months after treatment was started, and no drug-related side effects were reported.

Inclisiran should be considered as a viable therapeutic alternative for the management of pure hypercholesterolemia in patients with CKD who are intolerant to statin treatment because it achieves the optimal LDL cholesterol targets required by actual guidelines without side effects.