An acute rise of plasma Na+ concentration associates with syndecan-1 shedding during hemodialysis

Josephine Koch, Nienke M A Idzerda, Esmée M Ettema, Johanna Kuipers, Wendy Dam, Jacob van den Born, Casper Fm Franssen*

*Corresponding author for this work

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Abstract

An acute rise of plasma Na+ concentration associates with syndecan-1 shedding during hemodialysis. Am J Physiol Renal Physiol 319: F171-F177, 2020. First published June 15, 2020; doi:10.1152/ajprenal.00005.2020.-Endothelial dysfunction (ED) contributes to the high incidence of cardiovascular events in patients undergoing hemodialysis. Syndecan-1 in the endothelial glycocalyx can be shed into the circulation, serving as a biomarker for ED. As Na+ is a trigger for glycocalyx shedding, we now tested whether hemodialysis, with higher dialysate Na+ concentrations, is associated with more syndecan-1 shedding compared with standard hemodialysis (SHD). In this crossover study in 29 patients, plasma syndecan-1 was repeatedly measured during SHD and during Hemocontrol hemodialysis (HHD), which is characterized by initially higher dialysate and plasma Na+ levels. Courses of syndecan-1 were compared with linear mixed models. Syndecan-1 shedding was assessed by area under the curve analysis. Plasma Na+ increased early after the start of SHD and HHD, with higher values during HHD (30 min: 142.3 vs. 139.9 mM, P < 0.001). Syndecan-1 increased significantly during both conditions, but the percent change was higher (42.9% vs. 19.5%) and occurred earlier (120 vs. 180 min) during HHD. Syndecan-1 levels were significantly higher at 120 min during HHD compared with SHD (P < 0.05). Overall, syndecan-1 shedding was higher during HHD compared with SHD (means: 40.4 vs. 19.0 arbitrary units, P = 0.06). Lower predialysis plasma Na+ and osmolality were associated with greater intradialytic increases in syndecan-1 levels (both groups, P = 0.001). The rise in plasma syndecan-1 levels was more pronounced and occurred earlier during hemodialysis with higher plasma Na+ levels. Although we cannot prove that the rise in plasma syndecan-1 originates from the endothelial glycocalyx, our findings are compatible with Na+-driven endothelial glycocalyxderived syndecan-1 shedding.

Original languageEnglish
Pages (from-to)F171-F177
Number of pages7
JournalAmerican journal of physiology-Renal physiology
Volume319
Issue number2
Early online date15-Jun-2020
DOIs
Publication statusPublished - Aug-2020

Keywords

  • hemodialysis
  • sodium
  • syndecan-1
  • CHRONIC KIDNEY-DISEASE
  • ENDOTHELIAL GLYCOCALYX
  • ARTERIAL STIFFNESS
  • OXIDATIVE STRESS
  • NITRIC-OXIDE
  • STAGE
  • INFLAMMATION
  • DYSFUNCTION
  • EXPRESSION
  • MORTALITY

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