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. 2012 Nov;23(11):1900-8.
doi: 10.1681/ASN.2011121181. Epub 2012 Oct 18.

Damage of the Endothelial Glycocalyx in Dialysis Patients

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Free PMC article

Damage of the Endothelial Glycocalyx in Dialysis Patients

Carmen A Vlahu et al. J Am Soc Nephrol. .
Free PMC article

Abstract

Damage to the endothelial glycocalyx, which helps maintain vascular homeostasis, heightens the sensitivity of the vasculature to atherogenic stimuli. Patients with renal failure have endothelial dysfunction and increased risk for cardiovascular morbidity and mortality, but the state of the endothelial glycocalyx in these patients is unknown. Here, we used Sidestream Darkfield imaging to detect changes in glycocalyx dimension in dialysis patients and healthy controls from in vivo recordings of the sublingual microcirculation. Dialysis patients had increased perfused boundary region and perfused diameters, consistent with deeper penetration of erythrocytes into glycocalyx, indicating a loss of glycocalyx barrier properties. These patients also had higher serum levels of the glycocalyx constituents hyaluronan and syndecan-1 and increased hyaluronidase activity, suggesting the shedding of these components. Loss of residual renal function had no influence on the imaging parameters but did associate with greater shedding of hyaluronan in blood. Furthermore, patients with higher levels of inflammation had more significant damage to the glycocalyx barrier. In conclusion, these data suggest that dialysis patients have an impaired glycocalyx barrier and shed its constituents into blood, likely contributing to the sustained endothelial cell activation observed in ESRD.

Figures

Figure 1.
Figure 1.
Results of imaging parameters in dialysis patients and healthy controls. Dialysis patients had increased RBC DPerf and PBR compared with healthy controls. *P<0.05. ns, nonsignificant.
Figure 2.
Figure 2.
Results of imaging parameters in PD patients, HD patients, and healthy controls. Both PD (n=17) and HD (n=23) patients had significant alterations of RBC DPerf and PBR compared with healthy controls (n=21). *P<0.05.
Figure 3.
Figure 3.
Relationship between serum levels of HA and total time on RRT in dialysis patients. A positive correlation was present between serum levels of HA and time on RRT (r2=0.32, P=0.0002).
Figure 4.
Figure 4.
Schematic illustration of endothelial glycocalyx imaging method. In dialysis patients, perturbation of glycocalyx allows the erythrocytes to approach the vessel wall, leading to increased DPerf and PBR compared with healthy controls. RBC width, median RBCW. DPerf is the perfused diameter (RBC perfused lumen). **PBR is the perfused boundary region (RBC-permeable part of the cell-free layer including cell-permeable glycocalyx). ***Cell-free layer.

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