Sleeve Gastrectomy Improves Heart, Kidney MRI Markers in Youth-Onset T2D

Vertical sleeve gastrectomy (VSG) was associated with reductions in left ventricular (LV) mass, albuminuria, and total kidney volume, along with improved kidney tubular oxygen handling, 12 months after surgery in youth with obesity and type 2 diabetes (T2D), according to findings presented at ASN Kidney Week 2026 in Denver, Colorado.1

At baseline, youth with obesity or youth-onset T2D already showed greater LV wall thickness than normal-weight peers.1

“Even at a young age, compared with normal-weight controls, both obesity and youth-onset type 2 diabetes have measurable changes in both cardiovascular and kidney parameters,” Phoom Narongkiatikhun, MD, of the University of Washington School of Medicine and Chiang Mai University, told HCPLive. “This is encouraging because it highlights the potential opportunity to do something.”

Youth-onset T2D leads to heart failure and kidney failure decades earlier than adult-onset disease.¹,² Narongkiatikhun explained metabolic surgery is known to improve weight, glycemic control, and cardiovascular risk factors, but less is known about how these gains translate into structural and physiological changes detectable by advanced imaging.

Which Cardiac and Kidney Changes Appear Early in Youth-Onset Type 2 Diabetes?

Investigators harmonized baseline data from 3 cohorts, IMPROVE-T2D, ULTRA-T2D, and SWEET-HEART, into a dataset of 58 participants.¹ The cohort included 4 normal-weight controls, 10 youth with obesity without diabetes, and 44 with youth-onset T2D. All underwent cardiovascular MRI, including cine volumetry, wall thickness, strain, T1 and T2* mapping, and 4D flow–derived aortic pulse wave velocity (PWV) and wall shear stress.¹

Compared with normal-weight controls, LV wall thickness was greater in the obesity group (P < .05) and the T2D group (P < .01). Biventricular cardiac output was higher only in the obesity group, whereas aortic wall shear stress was higher only in the T2D group. Cardiac MRI phenotypes did not differ between the obesity and T2D groups.¹

Participants with severely increased albuminuria, defined as a urine albumin-to-creatinine ratio (UACR) of 300 mg/g or higher, had greater LV wall thickness (P < .05) and a higher resting heart rate (P < .01).¹ According to the investigators, these early cardiac perturbations tracked kidney disease severity.

How Did Sleeve Gastrectomy Change Cardiac and Kidney MRI Phenotypes?

In IMPROVE-T2D, 19 participants underwent cardiac and kidney MRI before and 12 months after VSG.¹ Kidney MRI quantified total kidney volume (TKV) and cortical and medullary furosemide-suppressible oxygen consumption (FSOC), an index of tubular oxygen handling.

At 12 months, LV mass decreased by 12.3 g and resting heart rate by 12 beats/min (both P < .01).¹ Aortic PWV fell by 12% (P = .02). TKV decreased by 69.5 mL (P = .04), and UACR declined by 28.2% (P = .022).¹

Medullary FSOC increased by 124% (P < .01), while glomerular filtration rate remained stable.¹ Narongkiatikhun called the FSOC finding the most notable result, noting it reflects changes in kidney physiology conventional clinical measures like eGFR and albuminuria might not capture.

Investigators noted larger studies with appropriate comparison groups and longer follow-up are needed to determine whether early imaging changes predict long-term cardiovascular and kidney outcomes.¹ Narongkiatikhun said future work will examine whether weight loss, glycemic control, or both drive these changes, and the mechanisms behind improvements in TKV and tubular oxygen handling. The broader aim, he said, is to “identify the potential treatment or intervention for these changes before the irreversible target organ damage occurs.”

References

1. Narongkiatikhun P, Choi YJ, Miller K, et al. Vertical sleeve gastrectomy is associated with improved cardiac and kidney phenotypes in youth with obesity and type 2 diabetes. Poster presented at: ASN Kidney Week 2026; October 21-25, 2026; Denver, CO. doi:10.1681/ASN.20266ty07qe0

2. TODAY Study Group; Bjornstad P, Drews KL, et al. Long-term complications in youth-onset type 2 diabetes. N Engl J Med. 2021;385(5):416-426. doi:10.1056/NEJMoa2100165