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It is driven by a combination of metabolic, hormonal, and inflammatory abnormalities associated with declining renal function. Summary: This review outlines the key mechanisms linking CKD to sarcopenia, including metabolic acidosis, uremic toxin accumulation, hormonal dysregulation, insulin resistance, and chronic inflammation. These factors impair muscle protein turnover and promote protein-energy wasting. The review also discusses diagnostic limitations and emerging therapeutic strategies, such as individualized nutrition, resistance training, and gut microbiota modulation. Key Messages: Sarcopenia in CKD contributes to increased morbidity and mortality. Early identification and personalized, multidisciplinary interventions are essential to preserve muscle health and improve patient outcomes.<\/jats:p>","DOI":"10.1159\/000551499","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T17:00:57Z","timestamp":1773766857000},"page":"312-325","source":"Crossref","is-referenced-by-count":3,"title":["Chronic Kidney Disease, Sarcopenia, and Hormonal-Metabolic Alterations: An Intriguing Association"],"prefix":"10.1159","volume":"51","author":[{"given":"Alessandro 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