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New research is shedding light on a high prevalence of sarcopenia among patients with chronic kidney disease (CKD) receiving dialysis, especially those on hemodialysis.¹

The systematic review included 62 studies with > 15,000 participants and determined the global prevalence of sarcopenia to be 30.1% for hemodialysis and 20.5% for peritoneal dialysis. Investigators additionally noted differences in prevalence based on which criteria was used and the timing of lean muscle mass (LMM) measurement.¹

Defined as the gradual loss of muscle mass, strength, and function, sarcopenia commonly affects the elderly population and is widely attributed to aging. However, chronic diseases like chronic obstructive pulmonary disease, kidney disease, diabetes, cancer, and HIV have also been identified as potential causes and exacerbating factors of sarcopenia.²

“Although several studies have reported the prevalence of sarcopenia in the CKD and dialysis population, there remains a significant lack of quantitative syntheses focusing on dialysis modality assessment criteria, timing of assessment, and the tools used for measuring muscle mass,” Ritin Fernandez, a professor at the University of Newcastle and assistant dean (International) at the College of Health, Medicine, and Wellbeing, and colleagues wrote.¹ “This gap limits the ability to draw meaningful comparisons and inform clinical practice.”

To address this gap in research, investigators systematically searched Ovid MEDLINE, Embase, Allied and Complementary Medicine Database, CINAHL, and Scopus electronic databases for studies assessing sarcopenia in adults ≥ 18 years of age with CKD undergoing dialysis.¹

Investigators retrieved an initial 174 articles, 62 of which met the inclusion criteria. These studies involved 15,382 participants (ranging from 20 to 3196 in each study), the majority of whom were receiving hemodialysis treatment (92%). All studies were published in the last 10 years, predominately in China (22%), Japan (19%), Korea (8%), and Taiwan (6%).¹

Results showed the global prevalence of sarcopenia was 30.1% (95% CIm 25.6%–39.9%; I2: 97.1%) among people receiving hemodialysis and 20.5% (95% CI, 15.1–26.4%; I2: 80.0%) among people receiving peritoneal dialysis. Investigators noted sarcopenia prevalence ranged from 23.1%-30.3% in hemodialysis and from 6.1%-26.9% in peritoneal dialysis based on the assessment criteria used.¹

To assess the effect of the timing of LMM assessment, investigators categorized studies using bioimpedance analysis (BIA) or bioimpedance spectroscopy (BIS) into pre- and post-dialysis. A total of 10 studies (n = 5177) investigated the LMM pre-dialysis with a sarcopenia prevalence of 24.2% (CI, 14.8%–35%; I2: 97.8%). When the same instrument was used post-dialysis (14 studies, n = 3502), the prevalence of sarcopenia was 33% (CI, 24.7%–41.7%; I2: 96.3%).¹

Further analysis revealed measuring muscle mass after dialysis using dual-energy X-ray assessment yielded a lower prevalence of sarcopenia (22.5%; CI, 12.9–33.8; I2: 93.3%) than BIA/BIS (33%; CI, 24.7–41.7; I2: 93.3%).¹

Investigators identified age, sex, diabetes, inflammation markers, nutritional indices, and dialysis vintage as risk factors for sarcopenia in the hemodialysis population but called attention to high heterogeneity between studies.¹

“There is a need for additional research to assess the practicality of various assessment tools and the role of other measurements or predictors of low muscle mass, strength, and sarcopenia,” investigators concluded.¹ “Global research would benefit from the development of a single criterion to be applied to dialysis patients and standardize screening tools for this population.”

References

1. Stockings J, Heaney S, Chu G, et al. Prevalence and Risk Factors of Sarcopenia in People Receiving Dialysis: A Systematic Review and Meta-Analysis. Seminars in Dialysis. https://doi.org/10.1111/sdi.70000

2. Cleveland Clinic. Sarcopenia. June 3, 2022. Accessed July 15, 2025. https://my.clevelandclinic.org/health/diseases/23167-sarcopenia

Countries are facing acute challenges and new opportunities in how HIV, viral hepatitis and sexually transmitted infections (STI) services are funded and delivered. In recent years and months, efforts to strengthen country ownership, integration and sustainability have accelerated as donor funding declines.

Many countries are increasingly adopting a primary-health care (PHC) approach to address HIV, viral hepatitis and STI epidemics as part of a broader holistic and people-centred approach to health.

A new policy brief Integrating HIV, viral hepatitis and sexually transmitted infections (STIs) with primary health care: learning from countries highlights progress and lessons learned from efforts to converge, link and integrate these services with PHC in several low- and middle-income countries.

The overall experiences from selected countries in this brief – Angola, Botswana, Brazil, Ethiopia, Indonesia, Kenya, Pakistan, Rwanda, Viet Nam, and Zambia – show varied challenges, approaches and outcomes aligned with the 4 strategic and 10 operational levers described in the WHO/UNICEF PHC Operational Framework.

Acting on only 1 or 2 levers limits impact and reach in the context of complex ecosystems. Countries that prioritized 4 or more areas at the same time – across both strategic and operational levels – achieved the most sustainable results. The integration of disease-focused responses and services with PHC has led to improved access to services, enhanced service delivery, stronger community engagement, improved health outcomes and sustainable financing. 

The policy brief recommends strengthening coordination and governance through strong political leadership, securing sustainable funding, and adopting a health system–focused approach. It advocates for task sharing within the health workforce and emphasizes meaningful community engagement to build trust and ownership. Addressing stigma and discrimination is a key priority, alongside leveraging digital technologies to improve service delivery. Finally, it highlights the importance of engaging the private sector to support innovation and expand reach.

Heather McArthur, MD, shed light on advancements in early breast cancer treatment, with a particular focus on immunotherapy and its evolving role. The discussion delved into current FDA approvals, promising clinical trials, and the considerations for patient selection and managing immune-related adverse effects.

In a conversation with CancerNetwork® during the 2025 International Congress on the Future of Breast Cancer East hosted by Physicians Education Resource LLC®, McArthur highlighted the current FDA approval of pembrolizumab for early-stage triple-negative breast cancer.^1,2 She also discussed the challenging yet promising future of combining immunotherapy with other standard treatments. A key challenge lies in the inability to co-administer CDK4/6 inhibitors with immunotherapy due to the risk of lung and liver toxicity.

The conversation also explored the evolving role of CDK4/6 inhibitors in the adjuvant setting for hormone receptor (HR)–positive, HER2-negative early breast cancer, emphasizing patient selection and duration of therapy. Looking ahead, McArthur expressed excitement about combination strategies involving antibody drug conjugates (ADCs) with immunotherapy for triple-negative disease in both neoadjuvant and high-risk residual disease settings. She also highlighted the potential for de-escalation strategies, where patients achieving a complete response with neoadjuvant therapy might forego additional treatment.

McArthur is the clinical director of Breast Cancer and Komen Distinguished Chair in Clinical Breast Cancer Research at the University of Texas Southwestern Medical Center.

What are the top line topics you discussed during your presentation today?

Today, we talked about innovation in immune therapy for the treatment of early-stage breast cancer. We talked about the current FDA approval for pembrolizumab for early-stage triple-negative breast cancer. We talked about promising clinical trials in estrogen receptor (ER)–positive high-risk early-stage breast cancer, and I presented data from our investigator-initiated trial in HER2–positive disease.

For HR-positive, HER2-negative early breast cancer, what are your thoughts on the evolving role of CDK4/6 inhibitors in the adjuvant setting, particularly concerning patient selection and duration of therapy?

Adjuvant CDK4/6 inhibitors have become a cornerstone of treatment for high-risk HR-positive disease, particularly those patients who have received prior chemotherapy. It will be challenging if the ongoing anticipated immunotherapy results from phase 3 KEYNOTE-756 [NCT03725059] trial, which demonstrated the 8.5% improvement in [pathological complete response with] neoadjuvant therapy with the addition of pembrolizumab, if that translates into an event-free survival [EFS] benefit and becomes another standard of care.³ The reason why that is complicated is that we cannot co-administer CDK4/6 inhibitors together with immune therapy because of the risk for lung and liver toxicity. That is a potential clinical challenge that we’ll be facing in the not-too-distant future.

How do you foresee immunotherapy’s role expanding into early breast cancer, particularly for high-risk triple-negative or HER2-positive subtypes? What are the key considerations for patient selection and managing immune-related adverse events?

We outlined a number of ongoing studies, particularly studies that are combining immune therapy with a promising new category of ADCs. We talked about studies that are ongoing, looking at patients who have high-risk residual disease after neoadjuvant therapy, being [randomly assigned] to the current standard of care, which is adjuvant immune therapy alone, vs immune therapy with one of these promising novel ADCs. There are studies that are moving even earlier in the course of disease, looking at ADCs with immune therapy going head-to-head against the FDA-approved phase 3 KEYNOTE-522 trial [NCT03036488] regimen, or part of the KEYNOTE-522 regimen.⁴

Looking 5 to 10 years out, what do you believe will be the most transformative advancements in early breast cancer treatment, and what research avenues do you think are most critical to get there?

That’s a difficult question to answer because the landscape has evolved so rapidly over the last few years, and so it would be anticipated that in 10 years, it will be dramatically transformed and hard to understand with the pace of drug development and novel technologies, exactly what will succeed in the next era.

Most eminently, I’m excited about combination strategies with ADCs together with immune therapy for the treatment of triple-negative disease, both in the neoadjuvant setting and in the high-risk residual disease setting. I’m also excited about so-called de-escalation strategies. If patients who achieve a complete response with neoadjuvant therapy, can they forego any additional therapy? Do they need to complete a year of therapy? I’m excited about those strategies as well.

In the HER2-positive space, we’re also seeing a lot of excitement around ADC strategies. Those successes from the metastatic setting have also moved into the curative intent setting. There will be a big ADC story there. I would also advocate for further exploration of immune therapy for HER2-positive disease. In the HR-positive space, there are a lot of exciting drugs that are in development, [including] a lot of exciting oral selective estrogen receptor degrader [SERD] combination strategies and oral medications. There’s a lot going on in that space, and it will be nice to have more oral options for our patients who are high-risk so that maybe they can forego chemotherapy as well.

What do you hope others will take away from this conversation?

I hope that people take away that there’s a huge amount of hope right now for both providers and patients, that we have had unprecedented drug approvals in recent years in all spaces. The whole field has transformed as a result; it’s a direct reflection of successful clinical trials. Enrollment in clinical trials is the way that we further advance the field. I would encourage people to continue to enroll their patients in clinical trials.

References

1. FDA approves pembrolizumab for high-risk early-stage triple-negative breast cancer. News release. FDA. July 26, 2021. Accessed July 14, 2025. https://tinyurl.com/4xm5y295
2. McArthur H. Immunotherapy for high-risk early-stage breast cancer: who benefits? Presented at the 2025 International Congress on the Future of Breast Cancer East; July 11-12, 2025, New York, NY.
3. Cardoso F, O’Shaughnessy J, Liu Z, et al. Pembrolizumab and chemotherapy in high-risk, early-stage, ER⁺/HER2^– breast cancer: a randomized phase 3 trial. Nat Med. 2025;31(2):442-448. doi:10.1038/s41591-024-03415-7
4. Schmid P, Cortes J, Dent R, et al. Overall survival with pembrolizumab in early-stage triple-negative breast cancer. N Engl J Med. 2024;391(21):1981-1991. doi:10.1056/NEJMoa2409932