Kidney: 17 papers
Peer-reviewed work on the endothelial glycocalyx, microvascular health and the ingredients in our formulas, newest first. Abstracts are indexed here and every paper links to the journal.
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Published paper
Erythrocyte Glycocalyx Reports Glomerular Endothelial Glycocalyx Damage in Disease and Predicts Glomerular Albumin Permeability
This paper, published in the Journal of the American Society of Nephrology, reports that the glycocalyx layer on red blood cells reflects damage to the glycocalyx of glomerular endothelial cells in the kidney. The authors propose the erythrocyte glycocalyx as an accessible marker that also predicts glomerular permeability to albumin. Only the title and citation were available, so the methods, population, and numerical results cannot be verified here.
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Published paper
Role of dietary interventions on microvascular health in South-Asian Surinamese people with type 2 diabetes in the Netherlands; a randomized controlled trial
This three-arm randomized, placebo-controlled trial tested a monthly 5-day fasting-mimicking diet (Prolon) versus a glycocalyx-mimetic supplement (Endocalyx, containing fucoidan, glucosamine sulfate and hyaluronic acid) versus placebo for 3 months in 56 South-Asian Surinamese patients with type 2 diabetes, with follow-up at 6 months. Sublingual microvascular measures were made with SDF imaging and GlycoCheck software. The fasting-mimicking diet lowered BMI and HbA1c temporarily but was associated with worsening of the dynamic perfused boundary region, while the supplement group showed improved dynamic PBR and microvascular health score and lower urinary MCP-1 relative to placebo.
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Published paper
Endothelial and Glycocalyx Biomarkers in Children With Sepsis After One Bolus of Unbalanced or Balanced Crystalloids
This single-center prospective cohort study followed 106 children with sepsis or septic shock who received a bolus of either balanced or unbalanced crystalloid fluid. Glycocalyx integrity was assessed by sublingual video microscopy (perfused boundary region) plus blood biomarkers. Children given unbalanced crystalloids showed more glycocalyx degradation at 6 hours, along with markers of vascular permeability and apoptosis, and higher odds of metabolic acidosis and acute kidney injury; the perfused boundary region normalized by 24 hours.
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Published paper
A Dietary Supplement Containing Fucoidan Preserves Endothelial Glycocalyx through ERK/MAPK Signaling and Protects against Damage Induced by CKD Serum
Researchers tested whether a commercial dietary supplement containing fucoidan, glucosamine sulfate, hyaluronan and antioxidants could protect the endothelial glycocalyx in laboratory models. Using atomic force microscopy on living endothelial cells, the supplement and fucoidan alone increased glycocalyx thickness, prevented heparinase-induced degradation, and reversed thinning caused by pooled serum from hemodialysis patients; effects depended on ERK/MAPK (and to a lesser extent PI3K) signaling and Golgi-dependent vesicular transport. In mice fed the supplement for two weeks, sidestream dark-field imaging of cremaster microvessels showed a reduced perfused boundary region, consistent with a thicker glycocalyx.
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Published paper
Perfused boundary region as biomarker for endothelial integrity in former preterms in adolescence
In the Belgian PREMATCH cohort, researchers measured sublingual perfused boundary region (PBR, an inverse index of glycocalyx thickness) by sidestream dark-field imaging in 93 adolescents born at extremely low birth weight (ELBW) and 87 healthy controls, alongside blood pressure, cystatin-C-based eGFR, and retinal vessel imaging. PBR did not differ between the groups even though ELBW survivors had higher blood pressure, lower eGFR, and altered retinal vessel width and tortuosity. The authors provide reference PBR values for adolescents but conclude that PBR correlates too weakly with other microvascular markers to serve as a stand-alone marker of endothelial integrity in this group.
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Published paper
The microvascular endothelial glycocalyx: An additional piece of the puzzle in veterinary medicine
This narrative review summarizes the structure, functions, and disease relevance of the endothelial glycocalyx (eGlx), with a focus on the near-absence of research in cats and dogs. It compares direct visualization methods (perfusion/immersion fixation electron microscopy, lectin staining) with clinically applicable indirect methods (ELISAs for shed hyaluronan, syndecan-1, heparan sulfate; sidestream dark-field imaging of the perfused boundary region). It also reviews evidence for glycocalyx damage in sepsis, kidney disease, hypervolemia and hypertension, and outlines candidate protective or restorative strategies.
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Published paper
Ways and Means of Cellular Reconditioning for Kidney Regeneration
This narrative review proposes 'cellular reconditioning' — repairing individual damaged cell components to trigger broader recovery — as an addition to regenerative nephrology. It catalogs mitochondrial, lysosomal/autophagy, and peroxisomal dysfunction alongside loss of endothelial glycocalyx integrity as interconnected contributors to acute and chronic kidney disease, and reviews the enzymes (metalloproteinases, heparanase-1, hyaluronidases) that shed the glycocalyx. It also summarizes clinical glycocalyx biomarkers and imaging methods, plus reported preventive and restorative interventions.
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Published paper
Mutations in the heparan sulfate backbone elongating enzymes EXT1 and EXT2 have no major effect on endothelial glycocalyx and the glomerular filtration barrier
Researchers tested whether people carrying a single defective copy of the heparan sulfate chain-elongating genes EXT1 or EXT2 (causing multiple osteochondromas) have a damaged endothelial glycocalyx or leaky glomerular filtration barrier. Using sublingual GlycoCheck measurements and urine albumin testing in 19 patients versus 19 matched controls, plus review of archived kidney biopsies from 24 osteochondroma cases, they found no meaningful differences. Only one archival case showed the rare fibrillar glomerular deposits previously described as 'glomerulopathy of hereditary multiple exostoses'.
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Published paper
Sublingual functional capillary rarefaction in chronic heart failure
Researchers used sidestream dark-field sublingual videomicroscopy (with perfused boundary region as a glycocalyx measure) to compare capillary density and glycocalyx dimensions in 50 chronic heart failure patients and 35 healthy age-matched controls. Heart failure patients showed substantially fewer functional and perfused capillaries, while glycocalyx thickness differed only marginally. Within the heart failure group, larger PBR (thinner glycocalyx) correlated with inflammatory markers and worse liver/kidney function measures.
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Published paper
Inflammatory and Angiogenic Factors Linked to Longitudinal Microvascular Changes in Hemodialysis Patients Irrespective of Treatment Dose Intensity
This 6-month prospective analysis of the multicenter INTHEMO study compared macro- and microvascular measures in hemodialysis patients receiving more than 12 hours per week of dialysis versus conventional regimens. Dialysis intensity did not predict changes in pulse wave velocity, ambulatory blood pressure, or sublingual glycocalyx measures. Instead, baseline inflammatory and angiogenic biomarkers predicted 6-month change in the perfused boundary region (PBR), a marker of glycocalyx integrity.
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Published paper
The Measurement of the Endothelial Glycocalyx as a New Biomarker of Endothelial Derangement in Systemic Sclerosis: A Challenge for the Future
This editorial discusses a companion study by Machin et al. that used automated sublingual microvascular imaging to assess endothelial glycocalyx and perfusion in systemic sclerosis (SSc). The authors argue that glycocalyx-related measures such as the perfused boundary region may detect functional microvascular derangement earlier than structural methods like nailfold videocapillaroscopy. They propose the glycocalyx as a candidate biomarker of endothelial disease activity in early SSc, while noting further validation is required.
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Published paper
Extracellular overhydration linked with endothelial dysfunction in the context of inflammation in haemodialysis dependent chronic kidney disease
This cross-sectional analysis of 72 haemodialysis patients compared fluid status (bioimpedance-derived overhydration) with macrovascular measures (pulse wave velocity, blood pressure), sublingual microvascular glycocalyx measurement (perfused boundary region by GlycoCheck), and a panel of inflammatory/endothelial biomarkers. Overhydrated patients had higher blood pressure and higher VCAM-1, thrombomodulin and IL-6 with lower leptin, while arterial stiffness and glycocalyx PBR did not differ between hydration groups. VCAM-1 was the strongest independent correlate of extracellular fluid excess.
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Published paper
Effects of ultrapure hemodialysis and low molecular weight heparin on the endothelial surface layer
In 20 hemodialysis patients, researchers measured the endothelial surface layer during dialysis sessions using sidestream dark-field imaging (perfused boundary region, PBR) and plasma markers of glycocalyx shedding, varying whether low molecular weight heparin was given at the start of dialysis or 120 minutes in. Plasma syndecan-1 rose significantly during hemodialysis, with the increase appearing to follow heparin administration, while PBR did not change measurably.
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Published paper
Association of kidney function with changes in the endothelial surface layer
This cross-sectional study used sublingual sidestream dark-field imaging (GlycoCheck) to measure the perfused boundary region (PBR), an inverse index of endothelial glycocalyx integrity, in men with end-stage renal disease, kidney transplant recipients, and healthy controls. Patients with ESRD and transplant recipients who developed interstitial fibrosis/tubular atrophy had larger PBR (worse glycocalyx) and higher circulating shed glycocalyx markers, whereas recipients with stable graft function were indistinguishable from controls. Reduced eGFR correlated with a larger PBR and higher endothelial activation markers.
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Published paper
Is the systemic microvascular endothelial glycocalyx in peritoneal dialysis patients related to peritoneal transport?
This small cross-sectional study measured the sublingual microvascular glycocalyx (perfused boundary region, PBR, and estimated blood vessel density) with sidestream dark-field imaging in 15 peritoneal dialysis patients and compared these with peritoneal membrane transport measured by a peritoneal permeability analysis. Overall, no associations were found between systemic glycocalyx measures and peritoneal transport. Some correlations appeared only in the subgroup of patients without fast peritoneal transport.
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Published paper
Damage of the endothelial glycocalyx in dialysis patients
This cross-sectional case-control study compared the sublingual microvascular glycocalyx in 40 dialysis patients (23 hemodialysis, 17 peritoneal dialysis) with 21 age- and sex-matched healthy controls using sidestream dark-field (SDF) imaging, plus blood markers of glycocalyx shedding. Dialysis patients showed a larger perfused boundary region (PBR) and perfused diameter, indicating red cells penetrating closer to the vessel wall, along with higher serum hyaluronan, syndecan-1, hyaluronidase activity, and sE-selectin. Higher inflammation (CRP >10 mg/L) and a history of cardiovascular disease were associated with greater PBR.
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Published paper
Acute ischemic injury to the renal microvasculature in human kidney transplantation
During transplant surgery, researchers used sidestream darkfield imaging to observe peritubular capillaries in kidneys from donors after cardiac death (DCD, substantial ischemia) and from living donors (minimal ischemia). DCD kidneys showed markedly poorer microvascular perfusion and biochemical and imaging signs of endothelial glycocalyx degradation, despite similar overall renovascular resistance. The authors conclude that ischemia-reperfusion in kidney grafts involves impaired capillary flow and loss of glycocalyx integrity.
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