I Am Losing Muscle Mass: What Should I Do?

Muscle loss can be a common and concerning issue for people with chronic kidney disease. If you are feeling weak, tired, or noticing changes in your body, talk to your doctor about how to maintain your muscle health and strength.

Muscle Health in Chronic Kidney Disease (CKD) and Dialysis

Losing muscle mass can be frustrating, scary, and even disabling. For people living with chronic kidney disease (CKD) or on dialysis (end-stage kidney disease, ESKD or end-stage renal disease, ESRD), muscle loss (called sarcopenia) is unfortunately very common. The good news? With the right nutrition, exercise, and medical care, you can slow or even reverse muscle loss.

Why Do People With CKD Lose Muscle Mass?

Muscle loss in CKD and ESKD isn’t just about “getting older.” Several kidney-related changes contribute to it:

• Chronic inflammation – accelerates muscle breakdown

• Metabolic acidosis – too much acid in the blood damages muscle tissue. The data on this is a bit unclear, but one lab value you can watch is the serum bicarbonate on your blood work — typically, a level above 22 mEq/L is considered normal.

• Dialysis-related losses – essential amino acids are lost during each dialysis session

• Hormone changes – including low vitamin D and altered muscle growth signals

• Poor appetite – many CKD/ESKD patients eat less protein and calories than needed

  
  

👉 Studies show sarcopenia affects anywhere from 5% to 60% of CKD patients, and the risk increases as kidney disease progresses. It is linked to higher hospitalization, heart disease, falls, and even reduced survival.

Nutrition for Muscle Preservation in CKD/ESKD on dialysis

Your protein and calorie needs depend on your CKD stage:

• Early CKD (Stages 1–3):

  • Sometimes a low-protein diet (~0.8 g/kg/day) is used to slow kidney decline.

  • But if you’re not eating enough calories, this diet may worsen muscle loss.

  • Avoid consuming less than 0.8 g/kg/day.

    
    

• Advanced CKD (Stage 4–5, not on dialysis):

  • Very-low-protein diets may be prescribed, but they should be supervised by a nephrologist and dietitian.

    
    

⚠️ Important: These should only be used short term, usually to buy time before starting dialysis. Long-term very low-protein diets are linked to malnutrition and reduced muscle mass.

• Dialysis / ESKD:

  • Higher protein is needed to replace what is lost during dialysis.

  • Most patients need 1.2–1.3 g/kg/day of protein. For a 70 kg (154 lb) person, that’s about 85–90 g protein per day.

  • Aim for enough calories to maintain weight and muscle.

    
    

🔎 Tip: Look for albumin on your dialysis lab sheet. It’s a marker of nutrition and should usually be greater than 4 g/dL. A level less than 3.8 g/dL is associated with worse outcomes for patients.

✅ The good news: Improving your nutrition and protein intake can often raise albumin levels over time, supporting better strength, recovery, and survival.

✅ Tips for nutrition:

• Focus on plant-forward proteins (beans, tofu, lentils) plus fish, eggs, or lean meats as recommended.

• Avoid very high protein intake (>1.5 g/kg/day) unless prescribed, since this may worsen kidney strain.

• Consider timing protein around dialysis sessions to replace losses.

Exercise: The Key to Building Strength

Nutrition alone isn’t enough — exercise is essential for maintaining and building muscle. The best results come from multi-modality programs that combine:

• Resistance training (strength): bands, light weights, sit-to-stands

• Aerobic training (stamina): walking, cycling, swimming

• Flexibility and balance: stretching, yoga, mobility

  
  

👉 Start slow and steady. Patients with CKD are at higher risk for heart disease. Before starting moderate or vigorous exercise, ask your doctor if you need a heart check or stress test.

🛡️ Safe Exercise Tips for CKD & Dialysis

Regular exercise, including both resistance training and aerobic activity, is crucial for preserving and building muscle mass, especially for individuals managing CKD or on dialysis. Starting a consistent fitness routine can significantly improve strength and overall independence.

✅ Start slow, go steady – Begin with short sessions (10–15 minutes) of light walking or resistance bands.

✅ Build up gradually – Increase time and intensity slowly over weeks, not days.

✅ Check your heart health – CKD increases risk for heart disease. Ask your doctor if you need a stress test or cardiac evaluation before higher-intensity workouts.

✅ Know your limits – Stop if you feel chest pain, dizziness, or severe shortness of breath.

✅ Stay consistent – Regular exercise (even at a light level) is more effective than occasional intense workouts.

✅ Include both types – Combine resistance (strength) and aerobic (stamina) training for the best results.

👉 12+ weeks of regular exercise can significantly improve strength, walking distance, and independence.

Even two to three 30-minute sessions per week can make a big difference. Workouts can be adapted for all levels, including chair exercises during dialysis.

FAQs About Muscle Mass and CKD

❓Why am I losing muscle with CKD?

CKD causes inflammation, dialysis-related amino acid loss, hormonal changes, and poor appetite, all of which lead to muscle breakdown.

❓How much protein do I need if I have CKD?

Most patients need ~0.8 g/kg/day (about 55 g for a 70 kg person). Plant based sources are always preferred. 

❓How much protein should I eat if I’m on dialysis?

Most dialysis patients need 1.2–1.3 g/kg/day (about 85–90 g for a 70 kg person). Always check with your nephrologist or dietitian.

❓Is exercise safe with CKD or dialysis?

Yes, if you start slow and check heart health first. Both aerobic and resistance exercise are safe and effective in CKD and ESKD.

❓Which exercise is best for muscle health?

The best results come from multi-modality programs—combining aerobic (walking, cycling) and resistance (weights, bands). Resistance training alone also helps build muscle.

❓Can I reverse muscle loss?

Yes—muscle strength and size can improve with nutrition + exercise, even in dialysis patients. Starting early leads to the best outcomes.

❓What if I don’t do anything about my muscle loss?

Untreated sarcopenia in CKD/ESKD increases the risk of falls, fractures, hospitalization, heart problems, and even reduced survival.

The Takeaway

If you are losing muscle mass with CKD or dialysis:

1. Check your diet – get enough protein and calories, matched to your CKD stage.

2. Exercise regularly – resistance + aerobic training is most effective.

3. Work with your care team – nephrologist, dietitian, and rehab specialists.

4. Act early – the sooner you start, the more muscle and strength you can preserve.

   
   

Maintaining muscle is not just about looks—it’s about living longer, feeling stronger, and staying independent.

Checklists to Stay on Track

📝 CKD Patient Muscle Health Checklist

☐ Eat protein as recommended by your doctor (~0.8 g/kg/day)

☐ Balance meals with enough calories

☐ Walk 10–15 minutes, 3–4x per week

☐ Do light resistance training 2–3x per week

☐ Track labs: creatinine, GFR, protein in urine etc.

📝 ESKD Dialysis Patient Muscle Health Checklist

☐ Eat 1.2–1.3 g/kg/day of protein (85–90 g/day for 70 kg person)

☐ Time protein around dialysis sessions

☐ Monitor albumin (goal ≥3.8–4 g/dL)

☐ Walk or cycle on non-dialysis days

☐ Do resistance training 2–3x per week

☐ Track labs: albumin, bicarbonate, potassium, phosphorus

👉 Download your free CKD & Dialysis Muscle Health Checklists here to keep yourself accountable and on track.