We read with interest the study by Yajima and Arao,1 who demonstrated robust associations between abdominal muscle density on computed tomography (CT) and handgrip strength (HGS) in hemodialyzed patients. Their work provides a practical and reproducible method for detecting impaired muscle quality using opportunistic CT. Yet translating these findings into clinical interpretation requires differentiating how and why muscle density declines, because similar Hounsfield unit (HU) values may arise from distinct biological processes with different prognoses and modifiability.