Association between body composition and its longitudinal changes with the progression of coronary artery calcification in hemodialysis patients

Coronary artery calcification (CAC) is a major contributor to cardiovascular disease (CVD) in patients undergoing maintenance hemodialysis (MHD). However, its association with body composition and longitudinal changes in body composition remains understudied to date. This study aimed to investigate the associations of body composition and its longitudinal changes with CAC progression in MHD patients. This prospective observational study included 209 Chinese MHD patients. Body composition was measured via bioelectrical impedance analysis, and CAC was assessed using the Agatston scoring system. Data were collected at baseline and 6 months later. The annualized change in CAC score (ΔCACS > 100) was used to define CAC progression. Unadjusted and adjusted binary logistic regression models were employed to evaluate the associations of body composition and its longitudinal changes with CAC progression, with adjustments for various clinical, biochemical, and demographic confounders. Of the 209 patients, 152 (72.73%) were classified into the CAC group (CACS > 0) and 57 (27.27%) into the non-CAC group at baseline. After 6 months, 193 patients completed two CT calcium scoring assessments; among these, 59 (30.57%) were assigned to the CAC progression group and 134 (69.43%) to the non-CAC progression group. Age, fat tissue index (FTI), extracellular-to-intracellular water ratio (E/I) and diabetes mellitus were significantly associated with an increased risk of CAC progression. Multivariate logistic regression analysis confirmed that age was an independent risk factor for CAC progression (OR = 1.033, 95% CI: 1.006–1.061, P = 0.018). Meanwhile, fat increase (follow-up FTI – baseline FTI > 0) during the follow-up period was an independent protective factor (OR = 0.435, 95% CI: 0.207–0.912, P = 0.028). Fat increase consistently exerted a protective effect against CAC progression (P < 0.05) independent of other covariates. Patients in the fat increase group had significantly higher muscle-related indices, including lean tissue index, lean tissue mass, and body cell mass (all P < 0.05). In contrast, the fat increase group had significantly lower BMI and fat-related indices, including FTI, total body fat (FAT), and adipose tissue mass (all P < 0.05). Dynamic monitoring of body composition indicated that underweight MHD patients with fat increase and maintained higher muscle mass had a lower tendency for CAC progression.