Lp(a) above 105 nmol/L flags cardiovascular risk in chronic kidney disease, but no targeted therapy yet exists, review (J Nephrol 2026)

Patients with chronic kidney disease (CKD) exhibit a higher cardiovascular risk compared to the general population, due to CKD itself and its associated metabolic disorders, such as dyslipidemia. While statin-based management is the current gold standard therapy for dyslipidemia in mild to moderate CKD patients, it has a limited effect on lipoproteins, other than low density lipoproteins such as Lp(a). This limitation should be taken into consideration in cardiovascular risk stratification. Furthermore, statin therapy has not shown any beneficial effects in dialysis patients without prior cardiovascular disease, leading to uncertainty regarding the optimal dyslipidemia management in kidney failure (KF) patients. In this context, high serum Lp(a) levels (>105 nmol/L) should be acknowledged as a significant cardiovascular risk factor due to their pro-atherosclerotic and pro-calcific effects. However, selective Lp(a)-lowering therapies are still lacking in current clinical practice, although novel therapies are emerging in promising Phase III randomized trials. This narrative review summarizes the role of Lp(a) in CKD and discusses current state of the art and future therapeutic strategies.