Associations of skeletal muscle volume and density with cardiovascular events in maintenance hemodialysis: a cross-sectional study

Cardiovascular events (CVEs) represent the leading cause of mortality in patients undergoing maintenance hemodialysis (MHD), particularly among older individuals with comorbid hypertension. While muscle volume and muscle density have emerged as promising markers associated with cardiovascular risk, their independent and synergistic roles in MHD patients remain insufficiently explored. In this cross-sectional study, a total of 391MHD patients from Taizhou People’s Hospital were enrolled. Skeletal muscle volume and density were quantified using axial computed tomography (CT) scans at the level of the first lumbar vertebra (L1), with image analysis performed via 3D Slicer software. Logistic regression analysis was applied to evaluate the associations between muscle-related parameters, age, hypertension, and CVEs. Model performance was assessed using receiver operating characteristic (ROC) curves and calibration plots. Patients who experienced CVEs exhibited significantly lower skeletal muscle volume and density, along with higher prevalence of hypertension and diabetes (all P < 0.05). In multivariable logistic regression, both muscle volume [odds ratio (OR) per 1 SD = 0.60, P < 0.01] and muscle density (OR per 1 SD = 0.65, P = 0.016) were independently associated with reduced risk of CVEs. The model showed good discrimination [area under the curve (AUC) ≈ 0.82] and acceptable calibration. Skeletal muscle health—particularly higher muscle density—was associated with lower odds of CVEs in MHD patients. These findings support incorporating muscle quality metrics (e.g., density) into cardiovascular risk assessment, especially in older and hypertensive subgroups.