Sarcopenia in Chronic Kidney Disease: A Narrative Review from Pathophysiology to Therapeutic Approaches

In chronic kidney disease (CKD), protein degradation outweighs protein synthesis, leading to imbalanced cellular protein turnover and a loss of protein and cell mass im-pairing tissue function. Sarcopenia, characterized by the progressive loss of skeletal muscle mass and strength, is a significant complication in CKD. In light of limited articles comprehensively synthesizing the clinical knowledge on sarcopenia, this narrative review explores the pathophysiological mechanisms linking CKD and sarcopenia, including metabolic, hormonal, inflammatory, and nutritional factors. Current diagnostic criteria and highlights of the role of gut microbiota dysbiosis and miRNA alterations in muscle wasting are also discussed. This review predominantly incorporates viewpoints from research from the past and a few classic papers to support the stance of this research. Therapeutic strategies are multifaceted, encompassing nutritional interventions, exercise, anabolic agents, vitamin D supplementation, and correction of metabolic acidosis. Emerging therapies targeting the gut-muscle axis and epigenetic modifications are also considered. Despite advancements, sarcopenia remains un-der-recognized and undertreated in CKD patients. Future research should focus on understanding the molecular pathways of sarcopenia, identifying novel biomarkers for early detection, and developing personalized treatment strategies. Addressing barriers to exercise and nutritional interventions is critical for successful implementation. Overall, sarcopenia in CKD is a multifaceted condition, involved in an interplay between metabolic, hormonal, inflammatory, and nutritional factors. Such mechanisms require comprehensive management strategies in practice, especially through nutritional interventions, pharmaco-logical approaches, and emerging therapies targeting the gut-muscle axis and epigenetic modifications. This review highlights the complex interplay of these mechanisms and underscores the importance of comprehensive management strategies. Nutritional interventions, including adequate protein and vitamin D supplementation and regular physical activity, are essential for mitigating muscle wasting. Pharmacological approaches, such as anabolic agents and anti-inflammatory treatments, show promise but require further research to establish optimal regimens. Emerging therapies targeting the gut-muscle axis and epigenetic modifications offer new avenues for treatment.