MSTN and Hyperammonemia: In addition to lifestyle factors, alterations to key catabolic molecular pathways (e.g., increased myostatin), impaired mitochondrial function, accelerated starvation, amino acid deprivation, chronic inflammation and hyperammonemia are all suggested to contribute to muscle loss in ESLD (Allen et al., 2020, 2022; Dasarathy & Merli, 2016).