{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:01:49Z","timestamp":1781154109681,"version":"3.54.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Cardiovascular disease is the leading mortality cause in elderly maintenance hemodialysis (MHD) patients, driven by coronary artery calcification (CAC). Elevated serum syndecan-1 (SDC1), a biomarker of endothelial glycocalyx degradation, indicates vascular dysfunction. This study explored the cross-sectional associations between serum SDC1, CAC severity, and intradialytic hypotension (IDH) in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled 88 elderly MHD patients and 30 healthy controls. Serum SDC1 was quantified, and CAC severity was assessed via computed tomography coronary artery calcium scores (CACS). IDH episodes were retrospectively reviewed from 3-month standardized dialysis records. Associations were analyzed using Spearman's correlation and multivariable ordinal logistic regression with a clinically prespecified sequential adjustment strategy. The discriminative stability of SDC1 was internally validated using the bootstrap resampling method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Serum SDC1 was significantly higher in MHD patients than controls (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). SDC1 strongly correlated with CACS (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.75,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), increasing progressively across CAC severity strata. After adjusting for demographics, clinical history, and mineral metabolism markers, elevated SDC1 was independently associated with greater CAC severity (Adjusted OR\u2009=\u20091.148, 95% CI 1.096\u20131.202,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Exploratory ROC analysis yielded a robust bootstrap-validated AUC of 0.920 (95% CI 0.867\u20130.974). An exploratory SDC1 threshold of 33.5\u2005pg\/mL identified a phenotype with higher CAC prevalence (86.9% vs. 7.4%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and more frequent IDH episodes (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Elevated serum SDC1 is independently associated with CAC severity and IDH incidence in elderly MHD patients. These findings suggest that SDC1, reflecting endothelial glycocalyx degradation, may serve as a potential indicator of vascular and hemodynamic instability. However, its exploratory role in risk assessment requires further prospective validation in independent cohorts before clinical application.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1842977","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:39:46Z","timestamp":1781152786000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Serum syndecan-1 correlates with coronary artery calcification severity and intradialytic hypotension in elderly hemodialysis patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Dian","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Nephrology, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Xi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhe","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghui","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital","place":["Huai'an, China"]},{"name":"Department of Nephrology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Zhao","sequence":"additional","affiliation":[{"name":"Special Needs Ward, The Affiliated Huai'an Hospital of Xuzhou Medical University and Huai'an Second People's Hospital","place":["Huai'an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1093\/eurheartj\/ehaf167","article-title":"Cardiovascular disease in chronic kidney disease","volume":"46","author":"Marx-Sch\u00fctt","year":"2025","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1038\/s41581-024-00854-w","article-title":"Treatment of chronic kidney disease in older populations","volume":"20","author":"Kishi","year":"2024","journal-title":"Nat Rev Nephrol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1001\/jama.2025.0610","article-title":"Cardiac CT calcium score","volume":"333","author":"Glynn","year":"2025","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1001\/jama.2025.21077","article-title":"Coronary computed tomography angiography in prediction of first coronary events","volume":"335","author":"Bergstr\u00f6m","year":"2026","journal-title":"JAMA-J AM MED ASSOC"},{"key":"B5","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1159\/000548408","article-title":"Calcium-phosphorus metabolism in chronic kidney disease and its relationship with vascular calcification","volume":"50","author":"Ran","year":"2025","journal-title":"Kidney Blood Press Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e31464","DOI":"10.1002\/jcp.31464","article-title":"Advances in the mechanisms of vascular calcification in chronic kidney disease","volume":"240","author":"Wang","year":"2025","journal-title":"J Cell Physiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2456690","DOI":"10.1080\/0886022X.2025.2456690","article-title":"Endothelial injury is one of the risk factors for the progression of vascular calcification in patients receiving maintenance dialysis","volume":"47","author":"Yao","year":"2025","journal-title":"Ren Fail"},{"key":"B8","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1146\/annurev-biochem-032620-104745","article-title":"Endothelial glycocalyx turnover in vascular health and disease: rethinking endothelial dysfunction","volume":"94","author":"Gomez Toledo","year":"2025","journal-title":"Annu Rev Biochem"},{"key":"B9","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s10456-024-09916-w","article-title":"Interleukin-6 drives endothelial glycocalyx damage in COVID-19 and bacterial sepsis","volume":"27","author":"Drost","year":"2024","journal-title":"Angiogenesis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1535673","DOI":"10.3389\/fmed.2025.1535673","article-title":"Role of the endothelial cell glycocalyx in sepsis-induced acute kidney injury","volume":"12","author":"Wang","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e70155","DOI":"10.1002\/mbo3.70155","article-title":"Glycocalyx and endothelial biomarkers as prognostic indicators in sepsis: a systematic review and meta-analysis","volume":"14","author":"Daniyarova","year":"2025","journal-title":"Microbiologyopen"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2732","DOI":"10.1016\/j.ekir.2025.04.055","article-title":"Serum syndecan-1 is associated with kidney and cardiovascular outcomes in idiopathic nephrotic syndrome","volume":"10","author":"Bauer","year":"2025","journal-title":"Kidney Int Rep"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1415788","DOI":"10.3389\/fcell.2024.1415788","article-title":"Syndecan-1 as a predictor of vulnerable atherosclerotic plaques","volume":"12","author":"Qiu","year":"2024","journal-title":"Front Cell Dev Biol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1038\/s41581-024-00863-9","article-title":"The impact of population ageing on the burden of chronic kidney disease","volume":"20","author":"Chesnaye","year":"2024","journal-title":"Nat Rev Nephrol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/toxins13010026","article-title":"Role of uremic toxins in early vascular ageing and calcification","volume":"13","author":"Kyriakidis","year":"2021","journal-title":"Toxins (Basel)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.jcmg.2024.07.024","article-title":"Coronary artery calcium density and risk of cardiovascular events: a systematic review and meta-analysis","volume":"18","author":"Yong","year":"2025","journal-title":"JACC Cardiovasc Imaging"},{"key":"B17","doi-asserted-by":"publisher","first-page":"165","DOI":"10.2147\/DMSO.S438618","article-title":"Similarities and differences of vascular calcification in diabetes and chronic kidney disease","volume":"17","author":"Wang","year":"2024","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B18","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s12882-020-02219-4","article-title":"Endothelial glycocalyx damage in kidney disease correlates with uraemic toxins and endothelial dysfunction","volume":"22","author":"Liew","year":"2021","journal-title":"BMC Nephrol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"101122","DOI":"10.1016\/j.xkme.2025.101122","article-title":"The endothelial glycocalyx: the first line of defense in the prevention and treatment of kidney diseases","volume":"7","author":"Yuan","year":"2025","journal-title":"Kidney Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"791309","DOI":"10.3389\/fmed.2021.791309","article-title":"Measuring the concentration of Serum syndecan-1 to assess vascular endothelial glycocalyx injury during hemodialysis","volume":"8","author":"Kusuzawa","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1016\/j.ekir.2024.03.024","article-title":"Association of calcium channel blocker use with intradialytic hypotension in maintenance hemodialysis","volume":"9","author":"Lefranc Torres","year":"2024","journal-title":"Kidney Int Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2077","DOI":"10.1007\/s40620-025-02288-4","article-title":"Prediction of intradialytic hypotension by machine learning: a systematic review","volume":"38","author":"Ninan","year":"2025","journal-title":"J Nephrol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"4325","DOI":"10.1007\/s11255-025-04645-5","article-title":"Risk factors for the development of intradialytic hypotension in patients undergoing maintenance hemodialysis","volume":"57","author":"Lv","year":"2025","journal-title":"Int Urol Nephrol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.1093\/cvr\/cvae164","article-title":"Calciprotein particle counts associate with vascular remodelling in chronic kidney disease","volume":"120","author":"Feenstra","year":"2024","journal-title":"Cardiovasc Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"16753","DOI":"10.1038\/s41598-023-44094-7","article-title":"Investigation of the relationship between intradialytic hypotension during hemodialysis and serum syndecan-1 concentration","volume":"13","author":"Oiwa","year":"2023","journal-title":"Sci Rep"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1842977\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:39:54Z","timestamp":1781152794000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1842977\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":25,"alternative-id":["10.3389\/fcvm.2026.1842977"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1842977","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"article-number":"1842977"}}