Mechanisms of muscle wasting in chronic kidney disease

Muscle atrophy frequently complicates the course of chronic kidney disease (CKD) and is associated with excess morbidity and mortalityCKD-induced mechanisms that cause muscle atrophy include activation of the ubiquitin–proteasome system, caspase-3 and myostatinTriggers that activate proteolysis in CKD include metabolic acidosis, defects in insulin/insulin-like growth factor 1 (IGF-1) intracellular signalling, inflammation and catabolic responses to microRNAsCurrent strategies aimed at preventing muscle atrophy include correction of acidosis plus exercise; specific therapies that inhibit myostatin or signal transducer and activator of transcription 3 (Stat3) are being developed