Given that syndecan-4 is the only syndecan with ubiquitous distribution (including heart and endothelial cells) [22–24], is essential for development of cardiac hypertrophy [15, 25], is required for endothelial alignment in flow, and is a potent antiatherosclerotic molecule[23], we hypothesized that it might be a potential biomarker useful in CV risk stratification in HD patients. Here, SDC4 is linked to cardiac hypertrophy.