"I Began Losing Strength Without Realising It": Muscle Loss Emerging As A Hidden Complication Among CKD Patients

For 58-year-old Rajesh Kumar (name changed), living with Chronic Kidney Disease (CKD) had already meant frequent hospital visits, medications and eventually dialysis. Over the past year, however, he noticed a more insidious change. Climbing stairs became difficult, his grip weakened and even short walks left him exhausted.

“I thought it was just weakness from dialysis,” he said. “But gradually I realised I was losing muscle and strength. I could not lift things that I used to handle easily.”

Doctors later diagnosed him with Sarcopenia, a condition marked by progressive loss of skeletal muscle mass and strength — increasingly recognised as a major complication among patients with kidney disease.

His case is not an isolated one. Nearly one in four patients with CKD in Asia also experience sarcopenia, highlighting a significant but often overlooked dimension of kidney disease, according to a systematic review and meta-analysis published in the Indian Journal of Nephrology.

The study analysed 43 studies involving 15,832 patients across Asia and found that about 25% of CKD patients are affected. The emergence of sarcopenia is particularly concerning at a time when the burden of CKD itself is steadily rising, potentially increasing the number of patients vulnerable to muscle loss and functional decline.

The research which was conducted by teams from the Shri M P Shah Government Medical College, Jamnagar, Gujarat and Zagazig University, Egypt, using the 2019 criteria developed by the Asian Working Group for Sarcopenia have called for multidisciplinary care involving nephrologists, nutritionists and rehabilitation specialists, along with more long-term studies to better understand disease progression.

The analysis showed that sarcopenia was significantly more prevalent among patients undergoing dialysis. Around 30% of dialysis patients were affected, compared with 14% among those not on dialysis. Among treatment modalities, peritoneal dialysis patients showed the highest prevalence at nearly 40%.

“Muscle wasting in CKD is driven by several overlapping biological processes, including accumulation of uremic toxins, chronic inflammation, hormonal disturbances and metabolic acidosis,” said Jay Nagda, one of the study’s authors.

“These factors accelerate protein breakdown and reduce muscle synthesis, making CKD patients particularly vulnerable to rapid muscle loss,” he added.

Nephrologists say that despite its high prevalence, sarcopenia is frequently missed in clinical practice.

Dr. D Bhowmik, Professor and Head of Nephrology at the All India Institute of Medical Sciences (AIIMS), Delhi, who was not part of the study agreed with the observation, saying that the condition remains under-recognised.

“Sarcopenia is still an overlooked entity in chronic kidney disease patients,” Dr. Bhowmik said. “In routine practice, we tend to assess nutritional status using parameters such as body weight, waist-hip ratio or mid-arm circumference. However, diagnosing sarcopenia requires evaluation of muscle strength through functional tests and exercise capacity.”

He pointed out that sarcopenia is closely linked to frailty, a syndrome associated with low physical activity, increased risk of falls and poorer outcomes.

Dr. Bhowmik added that studies conducted at AIIMS have shown a strong association between malnutrition and frailty among both dialysis and non-dialysis CKD patients.

“We have observed that frailty is not confined to the elderly; it is also prevalent among younger CKD patients,” he said.

“In fact, sarcopenia forms part of a clinical cluster that includes protein-energy malnutrition and frailty. Addressing malnutrition can help improve frailty and overall patient outcomes,” he noted, referring to findings presented at the World Congress of Nephrology and published in Kidney International Reports.

The study by the researchers from Jamnagar and Egypt University also reported wide variation across countries, with Japan recording the highest prevalence (38%) and Malaysia the lowest (5%), likely reflecting differences in demographics, diet and healthcare systems.

Advancing age emerged as the strongest risk factor, along with male sex, hypertension and diabetes.

“CKD patients often experience accelerated ageing of muscles,” said M Yogesh, the lead author. “When kidney disease combines with ageing, inflammation and metabolic disturbances, muscle degeneration progresses much faster.”

Sarcopenia is increasingly recognised as a serious complication because it contributes to reduced mobility, fatigue, increased hospitalisation and higher mortality.

“Loss of muscle mass significantly affects quality of life and can worsen clinical outcomes, especially among those receiving dialysis,” said Mohamed Mohsen Helal of Zagazig University.

Doctors note that muscle weakness can also make it harder for patients to tolerate treatment and recover from illness.

Experts emphasise that early identification can help prevent severe muscle loss.

“Sarcopenia should be considered a key component of CKD management,” Dr. Nagda said. “Regular assessment of muscle mass and strength can help clinicians identify high-risk patients and intervene early.”

Dr. Bhowmik also underscored the need for a comprehensive approach to care.

“CKD patients need proper evaluation for protein-energy malnutrition, sarcopenia and frailty. Good nutrition and a regular exercise training programme are essential to counter muscle loss,” said the senior nephrologist from the AIIMS Delhi.

The study highlights that resistance exercise combined with adequate protein intake (1.2–1.4 g/kg/day) can help slow muscle loss, particularly among dialysis patients. Managing metabolic complications such as inflammation and acidosis may further improve outcomes.

For patients like Rajesh Kumar, the condition has already reshaped daily life. “Dialysis was difficult,” he said. “But losing strength without realising it has been even harder.”