Dysfunctional high-density lipoprotein (HDL) might drive the high rate of cardiovascular events in patients on chronic haemodialysis and might explain why these patients seem resistant to statins, say researchers. Yamamoto et al. found that HDL from patients on chronic dialysis was less effective than HDL from controls in accepting cholesterol from macrophages. In vitro activation of cellular cholesterol transporters led to increased cholesterol efflux to both control HDL and HDL from dialysis patients, and the authors suggest that cellular cholesterol transporters might be targets for reducing cardiovascular risk in dialysis patients.