Role of glycocalyx damage in cardiac surgery as part of the mechanism of acute kidney injury

Background: Valve replacement surgery with cardiopulmonary bypass is associated with a systemic inflammatory response that may cause endothelial injury and contribute to renal dysfunction. The endothelial glycocalyx, a key structure for vascular integrity, can be disrupted during these procedures, leading to the release of circulating biomarkers that may allow early detection of subclinical renal injury. Objective: To evaluate the relationship between endothelial glycocalyx injury, circulating biomarkers (syndecan-1 and hyaluronic acid), and the risk of subclinical acute kidney injury (AKI) in patients undergoing valve replacement surgery with cardiopulmonary bypass. Material and methods: A prospective observational study was conducted in adult patients undergoing valve replacement at a tertiary cardiovascular center (n = 21). Serum syndecan-1 and hyaluronic acid levels were measured before and after surgery, and renal clearance was assessed. AKI was defined according to KDIGO criteria. Results: Postoperative increases in syndecan-1 and hyaluronic acid indicated glycocalyx injury. Patients with aortic cross-clamp times > 60 minutes showed reduced renal clearance of syndecan-1 (p < 0.05), suggesting subclinical renal dysfunction. Conclusions: Valve replacement surgery with cardiopulmonary bypass is associated with endothelial glycocalyx injury and subclinical impairment of renal function, detectable through circulating biomarkers.