Sarcopenia is prevalent in chronic hemodialysis patients. This prospective cohort study evaluated the impact of sarcopenia and its diagnostic criteria on hospitalization and mortality in 126 chronic hemodialysis patients. Skeletal muscle mass, handgrip strength (HGS), gait speed, and blood parameters were assessed. Sarcopenia was evaluated using the criteria of the European Working Group on Sarcopenia in Older People and the Taiwanese criteria for Sarcopenia. Muscle quality was defined as HGS divided by mid-arm muscle circumference. Prevalences of uremic sarcopenia were 8.7% and 13.5% according to Taiwanese and European criteria, respectively. Low HGS and gait speed were much more prevalent than low muscle mass. Within 3 years, 79 (62.7%) patients were hospitalized and 26 (20.6%) died. Low HGS and slow gait speed were associated with hospitalization and mortality, while sarcopenia was associated with mortality but not with hospitalization. Notably, in our patients without sarcopenia, close associations between increased hospitalization and mortality risk with low HGS and slow gait speed remained unchanged. In Cox proportional hazard analysis, muscle quality [hazard ratio (HR) = 0.42, 95% confidence interval (CI) = 0.19-0.93, p = 0.032] and serum creatinine (HR = 0.82, 95% CI = 0.71-0.95, p = 0.009) were independently associated with composite outcome of hospitalization or death. Muscle functionality and quality can predict hospitalization and overall survival in chronic hemodialysis patients, better than muscle mass.

Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.

Sclerostin, an antagonist of the Wingless-type mouse mammary tumor virus integration site (Wnt) pathway that regulates bone metabolism, is a potential contributor of chronic kidney disease (CKD)–mineral and bone disorder (MBD), which has various forms of presentation, from osteoporosis to vascular calcification. The positive association of sclerostin with bone mineral density (BMD) has been demonstrated in CKD and hemodialysis (HD) patients but not in peritoneal dialysis (PD) patients. This study assessed the association between sclerostin and BMD in PD patients. Eighty-nine PD patients were enrolled; their sera were collected for measurement of sclerostin and other CKD–MBD-related markers. BMD was also assessed simultaneously. We examined the relationship between sclerostin and each parameter through Spearman correlation analysis and by comparing group data between patients with above- and below-median sclerostin levels. Univariate and multiple logistic regression models were employed to define the most predictive of sclerostin levels in the above-median category. Bivariate analysis revealed that sclerostin was correlated with spine BMD (r = 0.271, P = 0.011), spine BMD T-score (r = 0.274, P = 0.010), spine BMD Z-score (r = 0.237, P = 0.027), and intact parathyroid hormone (PTH; r = − 0.357, P < 0.001) after adjustments for age and sex. High BMD, old age, male sex, increased weight and height, diabetes, and high osteocalcin and uric acid levels were observed in patients with high serum sclerostin levels and an inverse relation was noticed between PTH and sclerostin. Univariate logistic regression analysis demonstrated that BMD is positively correlated with above-median sclerostin levels (odds ratio [OR] = 65.61, P = 0.002); the correlation was retained even after multivariate adjustment (OR = 121.5, P = 0.007). For the first time, this study demonstrated a positive association between serum sclerostin levels and BMD in the PD population.

Sarcopenia, defined as low muscle mass and strength, is highly prevalent in patients undergoing chronic hemodialysis (HD). However, muscle function and muscle mass do not share the same clinical relevance. In fact, muscle strength was more closely associated with the risk of mortality in chronic HD patients than was muscle mass. Therefore, to identify the risk factors of muscle weakness is vital. Angiotensin II overexpression had been recognized to impair skeletal muscle strength. Accordingly, angiotensin II receptor blockers (ARBs) potentially possess a muscle protective effect. This cross-sectional study aimed to identify the factors associated with low muscle strength and to explore the relationship between ARB use and muscle strength in chronic HD patients. A total of 120 chronic HD patients, aged 63.3 ± 13.2 years, were included in this study. Basic characteristics, handgrip strength (HGS), body composition, and nutritional status were assessed, and blood samples for biochemical tests were obtained. We divided these participants into normal- and low HGS groups according to the consensus of the European Working Group on Sarcopenia in Older People (EWGSOP). We observed that 78 (65.0%) patients had low HGS. In our cohort, we found that height (r = 0.653; P < 0.001), weight (r = 0.496; P < 0.001), body mass index (r = 0.215; P = 0.020), skeletal muscle index (r = 0.562; P < 0.001), albumin (r = 0.197; P = 0.032), and serum creatinine (r = 0.544; P < 0.001) were positively and age (r = − 0.506; P < 0.001), subjective global assessment (SGA) score (r = − 0.392; P < 0.001), fractional clearance index for urea (Kt/V) (r = − 0.404; P < 0.001) and urea reduction ratio (URR) (r = − 0.459; P < 0.001) were negatively correlated with HGS. According to our analysis, age (Odds ratio, OR = 1.11, 95% confidence interval, 95% CI = 1.05–1.17, P < 0.001), HD duration (OR = 1.01, 95% CI = 1.00–1.02, P = 0.010), diabetes (OR = 13.33, 95% CI = 3.45–51.53, P < 0.001), Kt/V (OR = 1.61, 95% CI = 1.06–2.46, P = 0.027), and SGA score (OR = 1.19, 95% CI = 1.03–1.38, P = 0.017) were regarded as independent predictors of low HGS. In contrast, ARB use (OR = 0.25, 95% CI = 0.07–0.93, P = 0.039) was independently associated with preserved HGS in chronic HD patients, after adjustment for multiple confounding factors. Our study is the first report in chronic HD patients to indicate a potentially protective effect of ARB on muscle strength. However, further longitudinal follow-up and intervention studies are needed to confirm this finding.