Open access: 85 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
Apremilast improves endothelial glycocalyx and microvascular perfusion: a possible protective mechanism against COVID-19
In this randomized comparison, 90 patients with psoriasis received apremilast, etanercept, or cyclosporine for 4 months, with sublingual glycocalyx (perfused boundary region, GlycoCheck/SDF imaging), arterial stiffness, and echocardiographic measures assessed before and after treatment. Only apremilast was associated with a reduction in PBR (indicating thicker glycocalyx) and it produced greater improvements in microvascular perfusion, pulse wave velocity, central systolic blood pressure, and left ventricular strain than the comparators. The authors speculate that glycocalyx protection could relate to reported benefits of apremilast in COVID-19, but no COVID-19 outcomes were studied.
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Published paper
Links between Endothelial Glycocalyx Changes and Microcirculatory Parameters in Septic Patients
In this single-center prospective observational study, sublingual microcirculation (Cytocam incident dark field imaging) and glycocalyx perfused boundary region (PBR, GlycoCheck) were compared between adults with sepsis or septic shock and healthy age-matched volunteers. Septic patients had significantly increased PBR (indicating thinner glycocalyx) across all vessel diameter classes, and PBR in the smallest capillaries correlated inversely with capillary density measures. The authors conclude there may be a functional link between glycocalyx damage in the smallest capillaries and sepsis-related microcirculatory alterations.
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Published paper
Microvascular Differences in Individuals With Obesity At Risk of Developing Cardiovascular Disease
In a cross-sectional analysis of 813 middle-aged adults with overweight/obesity, sublingual microcirculation was imaged using sidestream dark-field video microscopy with new GlycoCheck software that adds red blood cell velocity analysis. Participants at high 10-year cardiovascular risk (Framingham) had fewer perfused small capillaries and faster red cell velocity than low-risk participants, whereas velocity-corrected perfused boundary region (a glycocalyx index) did not differ between risk groups.
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Published paper
May We Use Non-Invasive Indices of Aortic Stiffness and Endothelial Glycocalyx as Biomarkers for Idiopathic Pulmonary Artery Hypertension Follow-Up?
This single-patient case report tracks three annual evaluations (2018-2020) of a woman with idiopathic pulmonary arterial hypertension, comparing invasive hemodynamics and exercise capacity with two non-invasive systemic vascular measures: carotid-femoral pulse wave velocity (aortic stiffness) and sublingual perfused boundary region (endothelial glycocalyx, GlycoCheck). When her pulmonary vascular resistance worsened, glycocalyx measures worsened (higher PBR, lower red blood cell filling), and both improved after treatment was changed. The authors suggest these indices deserve further study as non-invasive follow-up markers, but a single case cannot establish this.
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Published paper
Identification of novel sublingual parameters to analyze and diagnose microvascular dysfunction in sepsis: the NOSTRADAMUS study (link to Critical Care)
This single-center observational study used sublingual sidestream dark-field videomicroscopy with a new GlycoCheck software version to analyze microvessels in 1-micrometer diameter classes (4-25 um) in 34 septic ICU patients and 17 healthy controls. Sepsis was associated with loss of the very smallest capillaries, impaired capillary recruitment, and increased perfused boundary region (indicating a thinner/more permeable glycocalyx). The authors combined capillary blood volume and PBR into a composite 'Microvascular Health Score' that separated patients from controls and correlated with sepsis severity.
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Published paper
Effect of gestational age and postnatal age on the endothelial glycocalyx in neonates
This prospective observational study used sidestream dark-field imaging with GlycoCheck software to measure the perfused boundary region (PBR, an inverse marker of endothelial glycocalyx thickness) in the skin microcirculation of 85 term and 39 preterm newborns. Preterm infants, especially those born before 30 weeks, had lower PBR (i.e., larger glycocalyx dimensions) than term infants, and PBR rose (glycocalyx thinned) with increasing postnatal age. Extremely preterm infants reached higher PBR values by 6-7 weeks of life than moderately preterm or term babies measured at the same corrected gestational age.
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Published paper
Does sublingual microscopy correlate with nailfold videocapillaroscopy in systemic sclerosis?
This single-center cross-sectional study compared automated sublingual videomicroscopy (GlycoCheck) with nailfold videocapillaroscopy (NVC), the standard test for scleroderma microvascular damage, in 39 systemic sclerosis patients on the same clinic day. Sublingual microvascular density correlated moderately with nailfold capillary number and inversely with the NVC microangiopathy evolution score. Functional measures (red blood cell fraction and glycocalyx perfused boundary region) did not correlate with NVC parameters in this mostly late-pattern cohort.
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Published paper
Assessment of the sublingual microcirculation with the GlycoCheck system: Reproducibility and examination conditions
This randomized, controlled methodological study tested how reproducible sublingual glycocalyx measurements with the GlycoCheck system (perfused boundary region, PBR, and red blood cell filling) are, and how they are affected by smoking, a high-calorie meal, and coffee. Reproducibility of single measurements was poor to moderate but improved substantially when 3-5 measurements were averaged, with no meaningful differences between investigators. All three acute exposures worsened PBR and RBC filling, with effects still detectable at 180 minutes.
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Published paper
Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity
This prospective observational study in Vietnam re-analyzed stored sublingual sidestream dark-field videos with GlycoCheck software and measured plasma syndecan-1 and endocan in 75 patients with confirmed dengue and 12 outpatients with other febrile illness. Patients with the most severe grade of plasma leakage showed a thinner, more degraded glycocalyx (higher perfused boundary region) and much higher plasma levels of shed glycocalyx proteoglycans during the critical illness phase. There were no significant glycocalyx differences between mild outpatient dengue and other febrile illnesses.
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Published paper
Microvascular dysfunction in COVID-19: the MYSTIC study
This prospective, multi-center cross-sectional study used sublingual sidestream dark-field video microscopy (GlycoCheck) plus blood biomarkers to characterize microvascular and endothelial glycocalyx changes in 23 hospitalized COVID-19 patients versus 15 healthy controls. Patients showed marked loss of small capillaries, slower red blood cell velocity, and evidence of glycocalyx damage, most pronounced in those on mechanical ventilation. Higher perfused boundary region (thinner glycocalyx) and lower ADAMTS13 were associated with 60-day in-hospital mortality.
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Published paper
Tocilizumab improves oxidative stress and endothelial glycocalyx: A mechanism that may explain the effects of biological treatment on COVID-19
Eighty patients with rheumatoid arthritis were randomized to 3 months of the IL-6 receptor blocker tocilizumab or to intensified conventional DMARDs plus glucocorticoids, with 40 age- and sex-matched healthy subjects as a comparison group. Endothelial glycocalyx thickness (sublingual perfused boundary region, PBR), arterial stiffness, echocardiographic myocardial work/strain, and inflammatory and oxidative stress markers were measured before and after treatment. Tocilizumab was associated with reduced PBR (indicating thicker glycocalyx), lower arterial stiffness, greater falls in CRP and oxidative stress markers, and greater improvement in myocardial deformation and work than conventional treatment.
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Published paper
Sex-related associations of high-density lipoprotein cholesterol with aortic stiffness and endothelial glycocalyx integrity in treated hypertensive patients
This cross-sectional study of 193 treated hypertensive patients examined whether HDL cholesterol levels relate to aortic stiffness (carotid-femoral pulse wave velocity) and endothelial glycocalyx integrity (sublingual perfused boundary region measured by sidestream dark-field imaging/GlycoCheck). Higher HDL-C was weakly and inversely associated with aortic stiffness in the whole group, and with PBR5-9 (a marker where higher values indicate a thinner glycocalyx) specifically in men, regardless of smoking status. No such glycocalyx association was seen in women, despite their higher HDL-C levels.
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Published paper
Variability of Microcirculatory Measurements in Critically Ill Patients
This study tested how reproducible sublingual GlycoCheck microcirculation measurements are in 60 critically ill patients, using repeated measurements by one or two experienced observers. Single measurements of glycocalyx thickness (perfused boundary region) showed poor reliability, while red blood cell filling percentage and vessel density were more consistent. Averaging three consecutive measurements substantially improved reproducibility for all parameters.
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Published paper
Decreased endothelial glycocalyx thickness is an early predictor of mortality in sepsis
Researchers measured sublingual glycocalyx thickness (as the perfused boundary region, PBR) with sidestream dark-field imaging and GlycoCheck software within 24 hours of ICU admission in 21 septic patients, and compared results with plasma markers and survival. Patients who did not survive to hospital discharge had a thinner glycocalyx (higher PBR) than survivors, and admission PBR discriminated survivors from non-survivors moderately well. PBR correlated with angiopoietin-2 but not with syndecan-1 or severity scores.
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Published paper
Effects of Glucagon Like Peptide 1 Receptor Agonists, Sodium Glucose Cotransporter 2 Inhibitors, and Their Combination on Endothelial Glycocalyx, Arterial Function, and Myocardial Work Index in Patients With Type 2 Diabetes Mellitus After 12 Month Treatme
In this 12-month randomized trial, 160 patients with type 2 diabetes were assigned to add-on insulin, liraglutide (GLP-1RA), empagliflozin (SGLT-2i), or the GLP-1RA/SGLT-2i combination. Despite similar HbA1c reductions across groups, the newer agents and especially the combination produced greater improvements in sublingual glycocalyx thickness (perfused boundary region), arterial stiffness, central blood pressure, and echocardiographic myocardial strain and work indices than insulin.
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Published paper
Microvascular Alterations During Cardiac Surgery Using a Heparin or Phosphorylcholine-Coated Circuit
In this single-center randomized, blinded trial, 26 adults having on-pump CABG surgery received either a heparin-coated or a phosphorylcholine-coated cardiopulmonary bypass circuit. Sublingual sidestream dark-field imaging (GlycoCheck) and plasma shedding markers showed glycocalyx thinning and shedding in the phosphorylcholine group but not the heparin-coated group, while the fall in perfused vessel density during bypass was similar in both groups.
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Published paper
In Vivo Imaging of the Buccal Mucosa Shows Loss of the Endothelial Glycocalyx and Perivascular Hemorrhages in Pediatric Plasmodium falciparum Malaria
Researchers used incident dark-field video microscopy of the inner cheek (buccal mucosa) in Tanzanian children to measure the perfused boundary region (PBR), an inverse indicator of endothelial glycocalyx thickness, alongside plasma glycocalyx shedding markers. Children with severe malaria had a significantly increased PBR and higher circulating hyaluronic acid, heparan sulfate, sulfated glycosaminoglycans, syndecan-1 and glypican-1 than healthy controls, consistent with substantial glycocalyx loss. Imaging also revealed perivascular hemorrhages and sequestering late-stage parasites, and markers of vascular instability (low angiopoietin-1, high angiopoietin-2) tracked with these changes.
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Published paper
Uncoupling of Microvascular Blood Flow and Capillary Density in Vascular Cognitive Impairment
Researchers used sublingual video microscopy (GlycoCheck system) to compare how the smallest blood vessels respond to spontaneous changes in blood flow in 15 men with vascular cognitive impairment from cerebral small vessel disease and 15 male controls. In healthy controls, the number of red-cell-perfused capillaries rose as feed vessel flow rose, whereas in patients with cognitive impairment it did not. The authors interpret this as an uncoupling of microvascular flow from perfused capillary density, which could limit oxygen and nutrient exchange when metabolic demand increases.
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Published paper
Association of sublingual microcirculation parameters and endothelial glycocalyx dimensions in resuscitated sepsis
In 30 ICU patients with resuscitated sepsis and 10 healthy controls, researchers simultaneously measured endothelial glycocalyx dimensions (sublingual perfused boundary region, PBR, via GlycoCheck) and conventional sublingual microcirculation parameters (incident dark field imaging). Septic patients had both thicker PBR (indicating glycocalyx damage) and impaired microvascular perfusion, and both correlated with markers of illness severity, but the two sets of measures did not correlate with each other. PBR values agreed well with circulating syndecan-1 and with glycocalyx thickness measured by atomic force microscopy in endothelial cells exposed to patient serum.
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Published paper
Effects of Different Antidiabetic Medications on Endothelial Glycocalyx, Myocardial Function, and Vascular Function in Type 2 Diabetic Patients: One Year Follow-Up Study
One hundred people with poorly controlled type 2 diabetes were assessed before and 12 months after intensifying their antidiabetic treatment, with measurements of arterial stiffness, brachial artery flow-mediated dilation, sublingual endothelial glycocalyx (perfused boundary region by GlycoCheck), heart muscle deformation on echocardiography, and blood markers of oxidative stress. Average HbA1c fell from 8.9% to 7.1%, and this was accompanied by lower arterial stiffness, a smaller perfused boundary region (suggesting a thicker/less penetrable glycocalyx), better endothelial and left ventricular function, and lower oxidative stress markers. In multivariable analysis, incretin-based drugs (GLP-1 receptor agonists and DPP-4 inhibitors) were associated with these improvements over and above the fall in HbA1c.
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Published paper
Sublingual endothelial glycocalyx and atherosclerosis. A cross-sectional study
In the largest study of its kind, sublingual perfused boundary region (PBR, an indirect index of endothelial glycocalyx thickness) was measured once in 6,169 multi-ethnic adults and related to classical cardiovascular risk factors and self-reported cardiovascular disease. The smallest glycocalyx size (highest PBR quartile) was independently associated with female sex, older age, and diabetes, but not with prevalent cardiovascular disease, coronary heart disease/revascularization, or stroke. The authors conclude that PBR-estimated glycocalyx size does not track a high cardiovascular risk profile in a general population.
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Published paper
Early Onset Preeclampsia Is Associated With Glycocalyx Degradation and Reduced Microvascular Perfusion
This exploratory cross-sectional study used sublingual sidestream dark field imaging (GlycoCheck) plus blood markers to compare endothelial glycocalyx status in 137 third-trimester pregnant women. Women with early-onset preeclampsia (<34 weeks) showed greater glycocalyx degradation (higher perfused boundary region) and fewer capillaries filled with red blood cells than normotensive women, women with gestational diabetes, or those with late-onset preeclampsia. Circulating heparan sulfate proteoglycans and hyaluronic acid were also elevated in early-onset preeclampsia.
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Published paper
Derangement of the endothelial glycocalyx in sepsis
This narrative review describes the structure and functions of the endothelial glycocalyx and how it is degraded during sepsis. It covers glycocalyx roles in leukocyte adhesion, anticoagulation, vascular permeability and mechanosensing, methods of assessment (circulating syndecan-1, heparan sulfate, hyaluronan; electron and intravital microscopy; sidestream dark-field imaging with automated PBR analysis), and candidate protective strategies. The authors conclude that no treatment has yet been proven clinically effective and that links between glycocalyx damage, sepsis severity and DIC remain inadequately defined.
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Published paper
Induced Trf2 deletion leads to aging vascular phenotype in mice associated with arterial telomere uncapping, senescence signaling, and oxidative stress
Researchers deleted the telomere-protecting protein Trf2 in adult mice to force telomere 'uncapping' without shortening telomeres, then measured artery and microvessel function. Trf2 deletion produced senescence signaling, oxidative stress, impaired nitric-oxide-dependent vasodilation, thinner endothelial glycocalyx, reduced microvascular perfusion, and modestly higher systolic blood pressure — a pattern resembling normal vascular aging.
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Published paper
Impact of Intravenous Fluid Challenge Infusion Time on Macrocirculation and Endothelial Glycocalyx in Surgical and Critically Ill Patients.
This open randomized single-center trial compared fast (5-10 min) versus slow (20-30 min) infusion of a 5 ml/kg balanced crystalloid fluid challenge in 50 spinal surgery patients and 16 septic patients, measuring sublingual perfused boundary region (PBR, a marker inversely related to glycocalyx integrity) with GlycoCheck side-stream dark-field imaging plus standard hemodynamics. Fluid administration raised PBR regardless of infusion speed, with recovery by 60 minutes in surgical patients but persistent elevation in septic fluid responders. Infusion time did not change the rate of fluid responsiveness, though fast boluses produced a larger but transient blood pressure rise.
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Published paper
HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients
This cross-sectional study measured sublingual perfused boundary region (PBR 5-9 µm) with GlycoCheck sidestream dark-field imaging in 120 treated hypertensive patients over 50 and compared results across HDL-cholesterol tertiles. Patients in the highest HDL-C tertile (71-101 mg/dL) had a modestly lower PBR (thicker glycocalyx) than those with lower HDL-C. However, in multivariable analysis only BMI, not HDL-C, independently predicted PBR.
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Published paper
In vivo assessment of the human cerebral microcirculation and its glycocalyx: A technical report
This technical report describes the first in vivo measurement of the human cerebral microcirculation and its endothelial glycocalyx using sidestream dark-field (SDF) imaging with GlycoCheck software during brain surgery. Measurements were taken sublingually (as a reference), and from cortical and hippocampal surfaces in five epilepsy surgery patients, with a sterile slipcover over the camera required in the operating field. Vessel density and perfused boundary region (PBR) showed broadly similar patterns across the three sites, but the sterile slipcover itself altered the measured values.
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Published paper
Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives
This cross-sectional case-control study compared sublingual glycocalyx thickness (measured as perfused boundary region, PBR, by sidestream dark-field imaging/GlycoCheck) in 320 untreated hypertensive patients and 160 normotensive controls. Hypertensives had thicker PBR (indicating thinner, more damaged glycocalyx), stiffer arteries, lower coronary flow reserve, and reduced left ventricular longitudinal strain. Higher PBR remained independently associated with arterial stiffness, coronary microcirculatory dysfunction, and impaired myocardial deformation after adjustment for standard risk factors.
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Published paper
Bedside analysis of the sublingual microvascular glycocalyx in the emergency room and intensive care unit – the GlycoNurse study
This single-center observational study tested whether bedside sublingual glycocalyx measurement with sidestream dark-field imaging and GlycoCheck software is practical and reproducible in routine emergency and critical care settings. A physician's repeated measurements and measurements by eight trained nurses agreed closely, and the procedure was quick and well tolerated. Perfused boundary region (PBR) values were higher in ICU than ER patients and modestly correlated with markers of acute illness.
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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
Automated Measurement of Microvascular Function Reveals Dysfunction in Systemic Sclerosis: A Cross-sectional Study.
Researchers used automated sidestream dark-field videomicroscopy (GlycoCheck) of sublingual microvessels to compare 40 patients with systemic sclerosis to 10 age-matched healthy controls. Patients with systemic sclerosis had fewer perfused microvessels, lower red blood cell fraction, a larger perfused boundary region (indicating deeper red-cell penetration into the glycocalyx), and thinner glycocalyx measured by a separate manual leukocyte-passage method. The study is descriptive and shows that this automated method can distinguish patients from controls.
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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
Non-invasive assessment of microvascular dysfunction in patients with microvascular angina
This prospective study compared sublingual glycocalyx barrier properties (perfused boundary region, PBR) in 13 patients with microvascular angina (MVA), 13 volunteers, and 14 patients with obstructive coronary artery disease, and additionally measured myocardial perfusion reserve by adenosine stress cardiac MRI in the MVA patients. MVA patients had a larger baseline PBR than volunteers and lacked the normal PBR increase after nitroglycerin, suggesting reduced glycocalyx integrity. The PBR response correlated strongly with the MRI-derived transmural myocardial perfusion reserve index.
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Published paper
Protocol for intraoperative assessment of the human cerebrovascular glycocalyx.
This is a published study protocol (no results) for a multicenter prospective case-control study in the Netherlands that plans to image the endothelial glycocalyx intraoperatively in the human brain. Using sidestream dark-field video microscopy with GlycoCheck software, investigators will measure the perfused boundary region (PBR) and perfused diameter in sublingual, cortical, and (in epilepsy patients only) hippocampal microvessels. The hypothesis is that cerebrovascular glycocalyx thickness is reduced in temporal lobe epilepsy compared with controls, potentially linking glycocalyx damage to blood-brain barrier leakage and seizure susceptibility.
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Published paper
Side-by-Side Alterations in Glycocalyx Thickness and Perfused Microvascular Density During Acute Microcirculatory Alterations in Cardiac Surgery
This observational study of 36 coronary bypass patients used sublingual sidestream dark-field imaging (GlycoCheck) to track perfused vessel density and perfused boundary region (PBR, an inverse index of glycocalyx thickness) before, during, and after surgery. Onset of cardiopulmonary bypass was accompanied by a fall in perfused vessel density and a rise in PBR, while off-pump surgery showed no such deterioration. Postoperative recovery of both measures occurred with pulsatile but not nonpulsatile bypass flow.
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Published paper
Plasma free hemoglobin and microcirculatory response to fresh or old blood transfusions in sepsis
This secondary analysis of a randomized pilot trial compared transfusion of fresh (<10 days) versus old (>15 days) non-leukodepleted red blood cells in 20 septic ICU patients, measuring plasma free hemoglobin, sublingual microcirculation by sidestream dark-field imaging (including perfused boundary region as a glycocalyx index), and near-infrared spectroscopy variables. Plasma free hemoglobin rose after old blood transfusion despite similar free hemoglobin in the blood units themselves, while sublingual microcirculatory parameters, including PBR, did not change significantly in either group. Larger increases in plasma free hemoglobin correlated with decreases in microvascular density and less increase in tissue hemoglobin index.
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Published paper
Characteristics and determinants of the sublingual microcirculation in populations of different ethnicity
This population-based study used sidestream/oblique epi-illumination sublingual capillaroscopy with GlycoCheck software to measure capillary density and the perfused boundary region (PBR, an inverse proxy for glycocalyx thickness) in 252 Han Chinese, 220 She Chinese and 254 Flemish adults. Higher cardiovascular risk (age, BMI, cholesterol, Framingham score) was associated with greater functional capillary recruitment, and in perfused capillaries a higher BMI and higher blood pressure were associated with lower PBR (i.e. apparently thicker glycocalyx). Associations were consistent across the three ethnic groups, although absolute PBR and capillary density differed between Chinese and Flemish participants.
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Published paper
Sublingual microvascular glycocalyx dimensions in lacunar stroke patients
Researchers used sidestream dark-field imaging of the sublingual microcirculation to estimate glycocalyx thickness (via the perfused boundary region, PBR) in 31 patients with lacunar stroke and 19 healthy controls. Overall, PBR did not differ between stroke patients and controls, but the subgroup of stroke patients who also had white matter lesions on MRI showed a significantly larger PBR, suggesting a thinner or more permeable glycocalyx. The authors interpret this as evidence of impaired endothelial barrier function in more extensive cerebral small vessel disease.
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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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