Fernandez-Prado R, et al. - Researchers report on the outcomes of pelacarsen [also termed AKCEA-APO(a)-LRx and TQJ230], a hepatocyte-directed antisense oligonucleotide targeting the LPA gene messenger RNA, in patients with chronic kidney disease (CKD), given an increased risk of cardiovascular disease (CVD) is seen in CKD and statins may not be protective in advanced CKD. Thus, a recently published Phase 2 randomized controlled trial of pelacarsen in people with CVD should be good news for nephrologists. A safe and dose-dependent reduction in lipoprotein(a) [Lp(a)] levels by 35–80% was shown to be brought about by pelacarsen, and a Phase 3 trial [Lp(a)HORIZON, NCT04023552] is planned to run from 2020 to 2024. Unfortunately, Phase 2 trials did not include patients with estimated glomerular filtration rate < 60 mL/min or urinary albumin:creatinine ratio > 100 mg/g, and Phase 3 trial will not incorporate those with ‘significant kidney disease’. Insights into the role of Lp(a) in CVD in CKD patients would be afforded by optimized exclusion criteria for Lp(a)HORIZON.