Sarcopenia is a prevalent complication in patients with chronic kidney disease (CKD), particularly in patients with end-stage kidney disease (ESKD). The prevalence of sarcopenia range from 11% to 50% among ESKD patients and increases with age. Common etiological factors that contribute to sarcopenia in ESKD patients include aging, high burden of comorbidities, decreased appetite or insufficient energy and nutrient intake, increased protein catabolism, nutrient losses during dialysis treatment, and inflammation. The clinical relevance of sarcopenic condition in patients with ESKD is that it increases the risk of poor clinical outcomes such as increased fracture risk, increased hospitalization rate and mortality, and decreased quality of life. Since the first Sarcopenia Consensus Statement from the European Working Group on Sarcopenia for Older People (EWGSOP) was published in 2010, a substantial amount of research has been published, including CKD and ESKD patients on dialysis. Hence, the concept of sarcopenia has been extended to include a loss of muscle mass as well as a decrease in muscle strength or physical function. Moreover, the relative importance of sarcopenia and its individual components as independent predictors of mortality was evaluated in patients with ESKD. Recently, many assessment tools for sarcopenia have been developed, which can be used in both clinical practice and clinical research. Although these efforts have improved the management of sarcopenia in ESKD patients, several limitations still remain. Reliable diagnostic methods using specific cutoffs for muscle mass and strength that could be used for defining sarcopenia in ESKD patients are lacking. Moreover, interventions to reverse sarcopenia in ESKD patients usually include the use of oral energy and protein supplementation combined with supervised physical resistance exercise. However, the study results about these management strategies are controversial.   Given the fragile nature to sarcopenia in patients with ESKD, further considerations for the management of sarcopenia are needed to avoid adverse consequences. The major negative impact of sarcopenia on morbidity, mortality, and quality of life, as well as the management strategy in ESKD patients will be covered in this session.