Intermuscular Adipose Tissue in CKD: A Window into Muscle Quality and Health?

Patients with CKD often experience loss of muscle mass, altered muscle function, and low physical functionality, all of which contribute to increased mortality and morbidity. Mitochondrial dysfunction emerges early in the progression of CKD and may play a central role in physical dysfunction. Factors such as uremia, systemic inflammation, oxidative stress, and inappropriate activation of the renin-angiotensin-aldosterone system may play a role on mitochondrial dysfunction. On the other hand, the accumulation of ectopic adipose tissue in skeletal muscle, also known as intermuscular adipose tissue (IMAT), is a newly recognized factor in muscle function and physical performance. IMAT is a marker of muscle quality, adversely affecting local muscle function, and is associated with insulin resistance and systemic inflammation, conditions commonly observed in CKD. Nevertheless, the exact composition of IMAT and its relationship with mitochondria and muscle energetics in CKD is not fully understood. Evaluating the relationship between IMAT accumulation and mitochondrial dysfunction in CKD may unveil potential interventions to improve physical function and the quality of life of patients with CKD.