Editorial: Sarcopenia and nutrition in chronic kidney disease

and multifactorial, involving both disease and dialysis-related mechanisms. These include chronic inflammation, oxidative stress, hormonal imbalances, metabolic acidosis, uremia-induced protein-energy wasting, the physical and psychological burden of dialysis therapy, the presence of comorbidities, and reduced levels of physical activity (3). In addition, sarcopenia in CKD is influenced by demographic factors, comorbidity profiles, nutritional status and body composition, biochemical and metabolic markers, as well as treatment-related variables (4).In the current Research Topic, three studies addressed potential risk factors associated with sarcopenia in patients undergoing hemodialysis (HD). Liu et al. observed that patients on HD in southwest China with iron deficiency exhibited significantly lower handgrip strength compared with those without deficiency. No differences were found in muscle mass, except in a subgroup analysis among patients with overweight (β = 0.50, 95% CI: 0.17;0.84, p=0.004). Consistently, a Brazilian cohort study showed that reduced muscle strength (dynapenia) was independently associated with fatigue in patients on HD, regardless of the dynapenia phenotype (handgrip strength and/or sit-to-stand test) (Duarte et al., 2025). Moreover, another study showed that non-leisure-time physical activity was significantly associated with a reduced risk of developing sarcopenia (RR = 0.449, 95% CI: 0.248-0.814), reinforcing the protective role of an active lifestyle in patients on HD (Chang et al, 2025).In light of the burden of sarcopenia and its multifactorial determinants, appropriate screening and diagnosis are essential in patients with CKD and those undergoing dialysis. Despite its high prevalence (2,5), the definition and methods for sarcopenia screening and diagnosis vary, mainly due to disease-specificities, and there is no consensus on methods for assessment in this population (2). For screening, SARC- Malnutrition is a contributing factor to the development of sarcopenia, as it promotes skeletal muscle loss through weight reduction, protein and micronutrient deficiencies, which are essential for muscle function and hormonal regulation. Chronic inflammation further exacerbates malnutrition by inducing anorexia, reducing dietary intake, and increasing resting energy expenditure, thereby accelerating muscle catabolism. Additionally, malnourished individuals frequently present impaired physical performance and reduced physical activity, which contribute to muscle atrophy and potentiate the progression of sarcopenia (6).The coexistence of malnutrition and sarcopenia, referred to as malnutritionsarcopenia syndrome, has been associated with adverse outcomes, as described by Wang et al. The authors reported that malnutrition-sarcopenia syndrome is prevalent among patients on HD and represents a combined risk factor for vascular calcification and major adverse cardiovascular events, which include cardiovascular mortality or hospitalization due to acute myocardial infarction, acute heart failure, or stroke.Similarly, protein-energy wasting (PEW), a frequent form of malnutrition in patients with CKD, characterized by nutritional and metabolic alterations, is also prevalent in those on HD (7). In a Chinese cohort, 44.9% of patients on HD were diagnosed with PEW, which was independently associated with plasma fibroblast growth factor-23 (FGF-23) and Klotho, even after adjusting for covariables, highlighting their value as predictors of PEW in this population (Zhou et al, 2025).In summary, this Research Topic on Sarcopenia and Nutrition in CKD raises the complexity and clinical relevance of this condition by integrating evidence on key risk and protective factors, emerging tools for risk stratification and assessment, and the adverse outcomes associated with sarcopenia and malnutrition/PEW. These findings reinforce the need for early screening, accurate diagnosis, and more comprehensive approaches in this patient population.