Bempedoic Acid Therapy for Polycystic Kidney Disease

Inclusion Criteria: * ADPKD patients as defined by Pei-Ravine criteria * Age 18-60 years * Mayo Imaging Classifications (MIC) 1C-1E or MIC 1B with defined eGFR decline \>3 ml/min/1.73m2/yr (estimated from serum creatinine using the CKD-Epi equation) * Estimated glomerular filtration rate (eGFR) ≥35 ml/min/1.73m2 by CKD-Epi equation utilizing creatinine * Fluent English-speaking * Able to provide informed consent * Patients with and without current tolvaptan use (prescribed by primary nephrologist) at a stable dose for ≥3 months Exclusion Criteria: * Estimated GFR\<35 ml/min/1.73m2 (estimated from serum creatinine using the CKD-Epi equation) * Proteinuria \>500 mg/day * Current bempedoic acid (BA) use or history of hypersensitivity to BA * Diabetes (currently diagnosed, or fasting glucose \>125 mg/dL) * Serum uric acid \>10 mg/dL or 1 or more acute gout flare within the prior year * Known active hepatitis or abnormal baseline liver function tests (LFTs) which is defined for patients who are not taking concomitant tolvaptan as ALT, AST or direct bilirubin \>1.5X ULN (upper limits of normal), or, for patients taking tolvaptan, as an ALT, AST, or direct bilirubin \>ULN * Known unstable cerebral aneurysm * Active coronary artery disease, defined as presence of stable or unstable angina * Systemic disease (other than hypertension) likely to contribute to kidney disease (e.g., lupus) * Current use of simvastatin \>20 mg or pravastatin \>40 mg daily. * Pregnancy or lactation * Hemoglobin \<10 g/dL * Implanted ferromagnetic objects * Use of an investigational product within prior 30 days or 5 half-lives, whichever is longer