proposed that in hemodialysis-dependent CKD, extracellular fluid imbalance exhibits a positive correlation with endothelial dysfunction markers (e.g., vascular cell adhesion molecule 1 [VCAM-1] and matrix metalloproteinase-1 [MMP-1]), underscoring a bidirectional link between overhydration and endothelial injury (38). Here, VCAM1 is linked to endothelial dysfunction.