ORIGINAL RESEARCH article
Front. Physiol.
Sec. Renal Physiology and Pathophysiology
This article is part of the Research TopicCardiovascular–Kidney–Metabolic Syndrome: Interorgan Crosstalk, Pathophysiology, and TherapeuticsView all 8 articles
Low Skeletal Muscle Density is Independently Associated with Cardiac Valve Calcification in Dialysis Patients
Provisionally accepted
Meng-ting Li1
Jing-yuan Cao2
Min Li3
Zhen Zhao1
Min Yang3Zi-fan Wang1
Tian-ke Yu1Ping-ping Ju2Yu-jia Jiang4
Yao Wang4*
Xiao-xu Wang1,5*- 1Southeast University Zhongda Hospital, Nanjing, China
- 2The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
- 3First Affiliated Hospital of Soochow University, Suzhou, China
- 4Affiliated Hospital of Yangzhou University, Yangzhou, China
- 5Qilu Hospital of Shandong University, Jinan, China
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Assessing muscle characteristics is an emerging field for improving stratification of cardiovascular disease risks. However, the relationship between muscle characteristics and cardiac valve calcification (CVC) remains unclear. This study evaluated how muscle mass and muscle quality relate to the risk of CVC in dialysis patients. This study included dialysis patients from four centers in China who underwent chest computed tomography (CT) and echocardiography. Skeletal muscle index (SMI) and skeletal muscle density (SMD) were measured by opportunistic chest CT at the first lumbar vertebra level to assess muscle mass and muscle quality. Patients were categorized by calcified valves: no calcification, single-valve (aortic or mitral) calcification, and dual-valve calcification. Ordinal logistic regression assessed the relationships of SMI and SMD with CVC risk. Of 2,140 patients (mean age of 55 years, 58.8% male), 782 (36.5%) exhibited CVC: 550 (25.7%) with single-valve calcification, and 232 (10.8%) with dual-valve calcification. As SMD quartiles decreased, the ORs (95% CIs) for CVC consistently increased (1.22 [0.90–1.64], 1.46 [1.08–1.97], 1.49 [1.07–2.08]; P = 0.003) after adjusting for potential confounders. The OR (95% CI) for CVC associated with a 1 SD decrease in SMD was 1.20 (1.06–1.36; P = 0.004) in Model 3. Multivariable adjustments revealed no significant links between SMI and CVC risk. In this large multicenter study, we found that low SMD, but not low SMI, is independently associated with CVC in dialysis patients. Integrating SMD assessments into routine care may improve CVC management for this population.
Keywords: Skeletal muscle density, muscle quality, Cardiac valve calcification, Cardiovascular Diseases, Dialysis
Received: 22 Aug 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Li, Cao, Li, Zhao, Yang, Wang, Yu, Ju, Jiang, Wang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yao Wang, yaowang@yzu.edu.cn
Xiao-xu Wang, wangxxjy0124@163.com
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