Obesity Management and Chronic Kidney Disease

A Nationwide Epidemiological Study of Chronic Kidney Disease Prevalence in a High-Risk Patient Population Without Prior Diagnosis in Primary Health Care in Poland

Background/Objectives: Chronic kidney disease (CKD) affects 10 to 15% of the world population. Currently, there are no reliable epidemiological data on the prevalence of CKD in Poland. The aim of this study was to determine the prevalence of CKD in the population of high-risk primary health care patients without a prior diagnosis of CKD in the Polish population. Methods: This multicenter retrospective study examined 5100 patients from 28 medical institutions. Patients were eligible for the study if they were 60-75 years old or had a history of the risk factors such as hypertension, kidney disease other than CKD, diabetes, cardiovascular disease, or obesity. The study was carried out in two stages, each of which included a determination of serum creatinine levels along with an estimation of eGFR and a determination of albuminuria in a urine sample. Results: In total, 5100 patients were included in the final analysis. In the univariate analysis, it was found that as age and body mass index values increased, the risk of developing CKD increased; the same correlation was observed when assessing the presence of hypertension, diabetes, or heart failure. In the multivariate analysis, the negative effects of hypertension, age 60-75 years, diabetes, heart failure, cardiovascular diseases, and kidney disease other than CKD on the development of CKD were confirmed. Conclusions: The results indicate that CKD is a significant social problem among the Polish population with risk factors.

Palmitic Acid-induced Renal Injury: Unravelling the Molecular Mechanisms and the Protective Role of Lycopene

To understand the role of palmitic acid overload on renal physiology, we exposed female rats to palmitic acid (PA) beyond the physiological range reminiscent of a high-fat western diet. We then treated the rats with graded doses of lycopene (Lyc) to evaluate its potential remedial effect against PA-induced renal injury. Twenty-four rats were randomized into four groups as control (received vehicles; Free Fatty Acid Free Bovine Serum Albumin (BSA) and Olive oil; PA only [received 5 mM BSA-complexed PA]; while the other two groups received 10 and 20 mg/kg body weight of Lyc along with the BSA-complexed PA. The Olive oil-reconstituted Lyc was commenced at the seventh week of intraperitoneal PA injection (uninterrupted) until the nineth week. Our results show that palmitic acid PA overload caused renal lipid dystrophy, characterized by decreased cholesterol, triglycerides, and phospholipids. We also observed elevated activities of lactate dehydrogenase and decreased activity of alanine aminotransferase. The activities of superoxide dismutase, myeloperoxidase, and malondialdehyde levels increased, while glutathione peroxidase activity decreased significantly. Furthermore, PA-induced disruption of cellular electrolytes is characterized by decreased calcium, chloride, sodium, and magnesium ions, and elevated activities of Na+/K+, and Ca2+/Mg2+ ATPases. Western blot analysis shows decreased Nrf2 expression, while NF-KB and Toll -Like Receptor 4 (TLR4) increased. Furthermore, the mRNA expression of TLR4, IL-6, TNF-alpha, and IL-1β increased, while IL-10 decreased in PA only group. However, Lyc treated groups exhibits meaningful ameliorative potentials by abating oxidative stress, inflammation, lipid dystrophy, and iono-dysregulation. This study suggests lycopene supplementation might abate PA -invoked disruption of lipid metabolism, inflammatory signal propagation and disruption of innate antioxidant systems in female albino rats.

The Role of miRNAs as Early Biomarkers in Obesity-Related Glomerulopathy: Implications for Early Detection and Treatment

Obesity increases the risk of cardiovascular disease, diabetes and chronic kidney disease. Obesity-related glomerulopathy (ORG) is a potentially reversible cause of kidney disease that often progresses silently until it reaches irreversible stages. However, we are still lacking a sensitive and specific biomarker to identify patients with obesity who are at risk of developing CKD. The role of microRNAs (miRNAs) has emerged as a promising area for diagnostic and therapeutic applications in kidney disease. Recent research has highlighted the specific roles of various miRNAs in renal function, showing that their dysregulation can contribute to the development of kidney diseases. This review will discuss the emerging role of miRNAs in the context of ORG, focusing on their potential as biomarkers and therapeutic targets for this increasingly prevalent disease.

Long-term trajectory of estimated glomerular filtration rate in ambulatory patients with type 2 diabetes and heart failure: clinical insights and prognostic implications

BACKGROUND

Although previous studies have evaluated renal function decline in patients with heart failure (HF), there is limited evidence on long-term renal trajectories, especially in patients with concomitant HF and type 2 diabetes (T2D). This study aims to provide a detailed analysis of renal function decline over an extended follow-up period in a well-characterized cohort of patients with HF and T2D.

METHODS

This is a post hoc subanalysis of a prospective registry involving ambulatory patients with HF and T2D referred to a specialized HF clinic. The estimated glomerular filtration rate (eGFR) was assessed at baseline and during scheduled follow-up visits every three months using the Chronic Kidney Disease Epidemiology Collaboration formula. Loess curves were plotted for predefined subgroups, and multivariable longitudinal Cox regression analyses were performed to evaluate the associations between eGFR trajectories and all-cause mortality.

RESULTS

A total of 1,114 patients with HF and T2D were included, with a mean age of 69.3 ± 10.3 years, and 68.2% were men. In total, 10,830 scheduled creatinine measurements were analysed, with a mean of 15.8 ± 9.4 measurements per patient. A significant progressive decline in the eGFR was observed, with an average annual rate of - 2.05 (95% CI - 2.11 to - 1.95, p < 0.001) ml/min/1.73 m2. Subgroup analysis indicated that older age, nonischaemic HF aetiology, HFpEF or HFmrEF, poor glycaemic control, and higher baseline eGFRs were associated with a more pronounced decline in renal function. Furthermore, a decrease in the eGFR was independently associated with an increased risk of all-cause mortality.

CONCLUSIONS

This study offers novel insights into long-term renal function trajectories in patients with HF and T2D and identifies key clinical factors associated with accelerated renal decline. Future research is warranted to validate these results in larger, more diverse cohorts and to explore potential therapeutic interventions.

Association of body round index with chronic kidney disease: a population-based cross-sectional study from NHANES 1999-2018

BACKGROUND

Complex nexuses between obesity and chronic kidney disease (CKD) have been reported. Nevertheless, the link between the body roundness index (BRI), an indicator utilized to measure body fat distribution, and CKD risk has been unexplored.

METHODS

We utilized publicly available data from ten survey cycles (1999-2018) of the National Health and Nutrition Examination Survey (NHANES) in the United States. We examined the association between BRI and CKD risk using multivariable logistic regression, subgroup analysis, interaction tests, and smooth curve fitting.

RESULTS

The study ultimately involved 41,953 participants, 3,123 (7.44%) of whom had CKD. Multivariable logistic regression, adjusted for covariates, identified high BRI levels in quartile 4 as a risk factor for CKD (OR = 1.30, 95% CI 1.12-1.50, P = 0.0005). This association remained consistent across subgroups (P for interaction > 0.05). Smoothed curve fitting exhibited a roughly linear positive correlation between BRI and CKD.

CONCLUSION

According to our study, BRI was related to CKD in a roughly linear way, suggesting a novel indicator for improving prevention and treatment for the CKD population. Nevertheless, additional research is needed to identify the association.

Psychiatric disorders and following risk of chronic kidney disease: a prospective cohort study from UK Biobank

BACKGROUND

Psychiatric disorders have been reported to influence many health outcomes, but evidence about their impact on chronic kidney disease (CKD) has not been fully explored, as well as possible mechanisms implicated are still unclear.

METHODS

Four hundred forty-one thousand eight hundred ninety-three participants from UK Biobank were included in this study. To assess the association between psychiatric disorders mainly including depression, anxiety, stress-related disorders, substance misuse as well as psychotic disorder, and CKD, a Cox regression model using age as the underlying time scale was employed. This approach considers the age progression of participants from the beginning to the end of the study as the elapsed time. Flexible nonparametric smoothing model was conducted to illustrate the temporal patterns. Subgroup analyses were performed by stratification of gender, genetic susceptibility to CKD, age at entry or exit the cohort, follow-up duration, and the number of psychiatric disorders at baseline. Mediation analysis was implemented to evaluate the roles of body mass index (BMI), hypertension, and diabetes.

RESULTS

Compared with individuals without psychiatric disorders, an increased risk of CKD was observed in patients with psychiatric disorders (hazard ratios (HR) = 1.52, 95% confidence intervals (CI): 1.40-1.65, p-value < 0.001). The hazard ratio among psychiatric patients gradually increased, and became significant after about 10 years follow-ups. The HR for patients followed up for 10-12 years was 1.60 (95% CI: 1.34-1.91, p-value < 0.001), and the HR was 1.66 (95% CI: 1.29-2.13, p-value < 0.001) for patients followed up for 12-13 years. Five distinct psychiatric disorders were found to be significantly associated with an increased risk of developing CKD. The highest HR was observed between stress-related disorder and CKD (HR = 1.95, 95%CI: 1.28-2.97, p-value = 0.002). When adjusting genetic susceptibility to CKD, the HR for the association between stress-related disorders and CKD became 1.86 (95%CI: 1.14-3.04, p-value = 0.013). Although these associations were nominally significant, they did not reach statistical significance after applying the Bonferroni multiple corrections, potentially due to the limited sample size. Subgroup analysis revealed that psychiatric patients who are under age 60, with multiple psychiatric morbidities or having been diagnosed with psychiatric disorders for over 10 years may be high-risk populations. Hypertension, BMI and diabetes mediated 49.13% (95% CI: 37.60%-67.08%), 12.11% (95% CI: 8.49%-17.24%) and 3.78% (95% CI: 1.58%-6.52%) of the total effect, respectively.

CONCLUSIONS

Psychiatric disorders were associated with a delayed onset of an elevated risk for CKD, this association was only observed in patients with psychiatric disorders for more than 10 years. Our study highlights the significance of lifestyle interventions, routine monitoring of kidney function, early screening for CKD, and personalized management strategies for psychiatric patients as potential approaches to the precise prevention of CKD.

Risk factors of acute kidney injury, septic shock and acute respiratory distress syndrome in patients with blood culture‑positive sepsis

Sepsis, a condition characterized by a dysregulated host response to infection, can progress to septic shock and lead to various complications. The present study aimed to identify risk factors for the early clinical identification of sepsis patients at heightened risk of complications. In the present study, a total of 383 hospitalized patients with sepsis and positive blood cultures were enrolled. Demographic characteristics, laboratory findings at admission and treatment outcomes were collected and analyzed. Among the 383 sepsis patients, 165 were diagnosed with acute kidney injury (AKI). Patients with AKI exhibited significantly lower platelet counts, elevated procalcitonin levels and higher Sequential Organ Failure Assessment (SOFA) scores. Logistic regression analysis identified the SOFA score [odds ratio (OR)=1.269, 95% confidence interval (CI): 1.067-1.510, P=0.007) as an independent predictor of AKI. Furthermore, patients with septic shock had lower platelet counts and higher white blood cell counts at admission. Multivariable analysis revealed that age (OR=1.024, 95% CI: 1.001-1.047, P=0.039), procalcitonin (OR=1.018, 95% CI: 1.003-1.032, P=0.015), SOFA score (OR=1.465, 95% CI: 1.248-1.719, P<0.001) and Pitt bacteremia score (OR=1.437, 95% CI: 1.204-1.716, P<0.001) were independently associated with septic shock. In addition, sepsis patients with acute respiratory distress syndrome (ARDS) were observed to have lower platelet counts, higher body weight and elevated alanine aminotransferase levels. Multivariable analysis identified the SOFA score (OR=1.177, 95% CI: 1.095-1.265, P<0.001) and body weight (OR=1.030, 95% CI: 1.007-1.054, P=0.010) as independent predictors of ARDS. The present study highlights the risk factors associated with AKI, ARDS and septic shock in sepsis patients with positive blood cultures. Early identification and close monitoring of these factors are crucial for improving outcomes in sepsis management.

The Association Between the Triglyceride-Glucose Index, Its Combination with the Body Roundness Index, and Chronic Kidney Disease in Patients with Type 2 Diabetes in Eastern China: A Preliminary Study

OBJECTIVES

This study aimed to investigate the relationship between the triglyceride-glucose (TyG) index, its combination with the body roundness index (BRI), and chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) based on a cross-sectional analysis conducted in Eastern China.

METHODS

The research originates from a cross-sectional study performed in Zhejiang Province, Eastern China, between March and November 2018. The TyG-BRI index was calculated based on triglyceride, fasting blood glucose, and the BRI. The correlation between the TyG-BRI index and the risk of CKD was assessed using a restricted cubic spline model. A multivariate logistic regression model was used to investigate the association between the TyG-BRI index and the risk of CKD. Receiver operating characteristic (ROC) analyses was used to evaluate the optimal cut-off and value of the TyG-BRI index for predicting CKD.

RESULTS

A total of 1756 T2DM participants were enrolled in this study. The TyG-BRI index was significantly higher in participants with CKD than in those without CKD. In the fully adjusted model, the odds ratios for CKD in the second, third, and fourth TyG-BRI quartiles were 0.93 (95% CI: 0.65-1.33), 1.33 (95% CI: 0.94-1.88), and 1.57 (95% CI: 1.10-2.25), respectively, compared to the first quartile. RCS analysis confirmed a linear dose-response relationship between the TyG-BRI index and CKD risk (all p for nonlinearity > 0.05). ROC curve analysis revealed that the TyG-BRI index had moderate predictive value for CKD, with an area under the curve of 0.626 (95% CI: 0.597-0.656, p < 0.001). The optimal cut-off value for the TyG-BRI index was 42.46, with a sensitivity of 68.2% and specificity of 52.2%.

CONCLUSIONS

The TyG-BRI index was positively associated with the risk of CKD in a T2DM population, demonstrating a dose-response relationship and moderate predictive value. It may serve as a valuable tool for identifying high-risk individuals and informing targeted interventions to prevent or delay CKD progression in this population.

Ultra-processed food consumption and the risk of incident chronic kidney disease: a systematic review and meta-analysis of cohort studies

BACKGROUND

Recent individual studies have indicated that ultra-processed food (UPF) consumption may be associated with the incidence of chronic kidney disease (CKD). We conducted a systematic review and meta-analysis based on those longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD, and synthesizing the results.

METHOD

PubMed, Embase, The Cochrane Library, Web of Science, and Scopus were searched from inception through 22 March 2023. Any longitudinal studies evaluating the relationship between UPF consumption and the risk of incident CKD were included. Two researchers independently conducted the literature screening and data extraction. RR and its 95% CI were regarded as the effect size. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of the studies included, and the effect of UPF consumption on the risk of incident CKD was analyzed with STATA version 15.1. This study's protocol was registered in PROSPERO (CRD42023411951).

RESULTS

Four cohort studies with a total of 219,132 participants were included after screening. The results of the meta-analysis suggested that the highest UPF intake was associated with an increased risk of incident CKD (RR = 1.25; 95% CI: 1.18-1.33).

CONCLUSIONS

High-dose UPF intake was associated with an increased risk of incident CKD. However, the underlying mechanisms remain unknown. Thus, more standardized clinical studies and further exploration of the mechanisms are needed in the future.

Lupus nephritis-related chronic kidney disease

Lupus nephritis is a common complication of systemic lupus erythematosus (SLE) and a determinant of overall morbidity and mortality, as lupus nephritis-related chronic kidney disease (CKD) drives cardiovascular disease and secondary immunodeficiency. Two lines of action are required to prevent the progression of lupus nephritis-related CKD: suppression of autoimmune SLE activity, which is a risk factor for immunopathology-related irreversible kidney injury, and management of non-immune risk factors that contribute to CKD progression. As each episode or relapse of active lupus nephritis implicates CKD progression, preventing flares of lupus nephritis is a key treatment target. Non-immune risk factors of CKD mostly include causes of nephron hyperfiltration, such as obesity, hypertension, sodium- or protein-rich diets and type 2 diabetes mellitus, as well as pregnancy. Nephrotoxic agents and smoking also drive kidney cell loss. Intrinsic risk factors for CKD progression include poor nephron endowment because of prematurity at birth, nephropathic genetic variants, ageing, male sex and previous or concomitant kidney diseases. Care for lupus nephritis involves the control of all modifiable risk factors of CKD progression. In addition, remnant nephron overload can be reduced using early dual therapy with inhibitors of the renin-angiotensin system and sodium-glucose transporter-2, whereas further renoprotective drug interventions are underway. As patients with lupus nephritis are at risk of CKD progression, they would all benefit from interdisciplinary care to minimize the risk of kidney failure, cardiovascular disease and infections.

Renal fat deposition measured on dixon-based MRI is significantly associated with early kidney damage in obesity

PURPOSE

To investigate the renal fat deposition on Dixon-based magnetic resonance imaging (MRI) and to explore the predictive value of renal fat biomarkers of magnetic resonance (MR-RFBs) for early kidney damage in obesity.

METHODS

This prospective study included 56 obese volunteers and 47 non-obese healthy volunteers. All volunteers underwent renal magnetic resonance examinations. The differences in MR-RFBs [including renal proton density fat fraction (PDFF), renal sinus fat volume (RSFV), and perirenal fat thickness (PRFT)] measured on Dixon-based MRI between the obese and non-obese volunteers were analyzed using a general linear model, taking sex, age, diabetes, and hypertension as covariates. The relationship between estimated glomerular filtration rate (eGFR) and demographic, laboratory, and imaging parameters in obese volunteers was examined by correlation analysis.

RESULTS

Obese volunteers had higher MR-RFBs than non-obese volunteers after controlling for confounders (all p < 0.001). Renal PDFF (r = - 0.383; p = 0.004), RSFV (r = - 0.368; p = 0.005), and PRFT (r = - 0.451; p < 0.001) were significantly negatively correlated with eGFR in obesity. After adjusting for age, sex, body mass index, diabetes, hypertension, visceral adipose tissue, subcutaneous adipose tissue, renal PDFF, and RSFV, PRFT remained independently negatively associated with eGFR (β = - 0.587; p = 0.003).

CONCLUSIONS

All MR-RFBs are negatively correlated with eGFR in obesity. The MR-RFBs, especially PRFT, may have predictive value for early kidney damage in obesity.

Weight Misperception is Prevalent Among Turkish Adults and Associated with Higher Age, Body Mass Index and Lower Education Status

Background

Weight misperception (WM) is common among adults, and it is associated with adverse health outcomes. Research has shown that various factors are associated with weight misperception. Turkish adult population data for weight misperception and related factors do not exist.

Methodology

We conducted a face-to-face cross-sectional descriptive survey in the general internal medicine outpatient clinics of two academic centers. Perception was analyzed both verbally and visually. Misperception was defined for both verbal and visual scales as being thinner than reality misperceptions (TTRM), fatter than reality misperceptions (FTRM), or either of them (ETFTRM). Demographics, anthropometrics, and social determinants of health were analyzed in different misperception groups.

Results

250 patients participated in the study. The median (interquartile range) age was 55 (14), and the BMI was 28.2 (6.9) for females and 26.9 (4.4) for males. 81.2% had ETFTRM, 45.2% had TTRM, and 22.4% had FTRM. Age and BMI were higher in the ETFTRM and TTRM groups, while education level was lower in both. Multivariate logistic regression showed that higher age, higher BMI, and lower education levels were associated with higher TTRM.

Discussion

WM is common among the Turkish adult population. Similar to the previous studies, aging, high BMI, and low education levels are associated with weight misperception. However, in contrast to previous studies, gender, marital status, and employment were not associated with weight misperception in our cohort.

Age and estimated glomerular filtration rate in Chinese older adults: a cohort study from 2014 to 2020

Objectives

This study aimed to fill the data gap of the course of renal function decline in old age and explore changes in renal function across different health states with increasing age.

Methods

This observational, retrospective, single-center cohort study included 5,112 Chinese older adults (3,321 men and 1,791 women, range 60-104 years). The individual rate of estimated glomerular filtration rate (eGFR) decline was analyzed using linear mixed-effects model to account for repeated measures over the years.

Results

The median age was 66 years, median BMI was 24.56 kg/m2, and median eGFR was 89.86 mL/min.1.73 m2. For every 1-year increase in age, women's eGFR decreased by 1.06 mL/min/1.73 m2 and men's by 0.91 mL/min/1.73 m2. We observed greater age-related eGFR decline in men and women with high systolic blood pressure (SBP). Men with high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C), had greater age-related eGFR decline. In women, different BMI groups showed significant differences in age-related eGFR decline, with the highest decline in those with obesity. Additionally, participants with normal baseline eGFR had a faster age-related decline than those with low baseline eGFR.

Conclusion

The eGFR declined linearly with age in Chinese older adults, with women exhibiting a slightly faster decline than men. Both men and women should be cautious of SBP. Older adults with normal baseline renal function experienced a faster eGFR decline. Men with high TG, LDL-C, and low HDL-C levels, as well as obese women, should be vigilant in monitoring renal function.

Cardiometabolic comorbidities and complications of obesity and chronic kidney disease (CKD)

Obesity and chronic kidney disease are two ongoing progressive clinical pandemics of major public health and clinical care significance. Because of their growing prevalence, chronic indolent course and consequent complications both these conditions place significant burden on the health care delivery system especially in developed countries like the United States. Beyond the chance coexistence of both of these conditions in the same patient based on high prevalence it is now apparent that obesity is associated with and likely has a direct causal role in the onset, progression and severity of chronic kidney disease. The causes and underlying pathophysiology of this are myriad, complicated and multi-faceted. In this review, continuing the theme of this special edition of the journal on " The Cross roads between Endocrinology and Nephrology" we review the epidemiology of obesity related chronic kidney disease (ORCKD), and its various underlying causes and pathophysiology. In addition, we delve into the consequent comorbidities and complications associated with ORCKD with particular emphasis on the cardio metabolic consequences and then review the current body of evidence for available strategies for chronic kidney disease modulation in ORCKD as well as the potential unique role of weight reduction and management strategies in its improvement and risk reduction.

Prevalence of chronic kidney disease and metabolic related indicators in Mianzhu, Sichuan, China

Background

Chronic kidney disease (CKD) is a major public health problem worldwide. Periodic surveys are essential for monitoring the prevalence of CKD and its risk factors. We assessed the prevalence of CKD and its risk factors in Mianzhu City in 2020.

Method

The Natural Population Cohort Study surveyed 7,770 individuals aged>20 years in Mianzhu City of Sichuan province in 2020. Our investigation encompassed the measurement of CKD prevalence, the evaluation of various renal function indicators, and comparisons based on age, gender, and hukou status. Additionally, some metabolic indices were also measured to identify the underlying causes of CKD.

Results

(1) Overall, the prevalence of reduced renal function (eGFR<60 mL/min/1.73m2), albuminuria, and CKD were 1.3, 10.0, and 10.4%, respectively, (2) the overall prevalence of CKD was higher among men than among women (14.5% vs. 8.6%). Similarly, the prevalence of CKD was higher among men than women in most age groups, (3) among urban residents, the prevalence of CKD was higher among middle-aged individuals and lower among young individuals and older adults, and (4) considering eGFR, the albuminuria and CKD for group definition, Blood pressure, triglyceride, high-density lipoprotein, blood sugar, and BMI were all statistically different among between normal groups and abnormal groups s in the albuminuria and CKD.

Conclusion

The incidence of CKD greatly varied between Mianzhu City and other regions in China and other countries. The differences in risk factors of CKD should be explored in the future. The gender difference in the prevalence of CKD in this study was markedly different from that in previous studies. More high-quality studies are needed to further explore this controversy. Based on the different prevalence of CKD and metabolism-related indices in rural and urban areas in this study, we speculated that the high incidence of CKD in Mianzhu City might be related to diet, lifestyle, and availability of healthcare services.

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

BACKGROUND

As the obesity crisis in the United States continues, some renal transplantation centers have liberalized their BMI criteria necessary for transplant eligibility. More individuals with larger body-habitus related comorbidities with End-Stage Renal Disease (ESRD) now qualify for renal transplantation (RT). Surgical modalities from other fields also interact with this patient population.

METHODS

In order to assess surgical outcomes of panniculectomy in the context of renal transplantation and ESRD, the authors performed a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines. Due to a paucity of existing primary studies, we retrospectively collected data on patients with ESRD undergoing panniculectomy from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) to evaluate outcomes of body contouring in this patient population.

RESULTS

From the systematic review, a total of 783 ESRD patients underwent panniculectomy among the studies identified. Of these, 91 patients underwent panniculectomy simultaneously to RT while 692 had their pannus resected prior to kidney transplant. The most common complication was hematoma followed by wound dehiscence. From the NSQIP database, 24 868 patients met the inclusion criteria for analysis. In the setting of renal transplant status, patients with diabetes, hypertension requiring medication, and requiring dialysis were more likely to suffer postoperative complications (OR 1.31, 1.15, and 2.2, respectively). However, upon sub-analysis of specific types of complications, the only retained association was between diabetes and wound complication.

CONCLUSION

Preliminary data show that panniculectomy in ESRD patients appears to be safe, though with a nominal increased risk for complications. Pannus resection does not appear to impact post-transplantation outcomes, including long-term allograft survival. Larger, higher powered, randomized studies are needed to confirm the safety, utility, and medical benefit of panniculectomy in the context of renal transplantation.

The Relationship Between Weight Indices and Blood Levels of Immunosuppressive Drugs in Renal Transplant Recipients

Background

Calcineurin inhibitors and mammalian target of rapamycin (mTOR) inhibitors are essential for maintaining transplanted organs. However, determining the appropriate dosage and predicting blood concentrations of these drugs based solely on net body weight may be inadequate. Previous studies have presented contradictory results regarding the impact of obesity on drug concentrations and transplant success.

Objectives

This study aims to evaluate various weight indices to identify the most reliable indicator of weight that correlates with the blood levels of drugs used in organ transplantation.

Methods

This retrospective descriptive study included patients from nephrology clinics affiliated with Isfahan University of Medical Sciences who were taking calcineurin and/or mTOR inhibitor drugs. Data extracted from medical records included demographic and clinical information, such as height, weight, and various weight indices (total/ideal/adjusted body weight, lean body mass (LBM), Body Mass Index, and predicted normal weight), as well as blood levels of immunosuppressive drugs at each patient's visit. The dosages of each drug (mg/kg) were analyzed to determine which weight indices best correlated with the obtained blood concentrations, using the Generalized Estimating Equation (GEE) model with logistic regression, an independent correlation matrix, and a binary distribution for data analysis.

Results

The study analyzed the medical records of 71 patients. Trough (C0) concentrations of drugs were evaluated in relation to each weight index, and odds ratios (OR) were calculated for statistical comparison. All weight indices increased the likelihood of achieving appropriate concentrations for cyclosporine, tacrolimus, and sirolimus. Drug dosing based on LBM (OR: 1.028), ideal body weight (OR: 1.075), and total body weight (OR: 1.041) showed the strongest correlations with achieving proper blood levels for cyclosporine, tacrolimus, and sirolimus, respectively.

Conclusions

Integrating various weight indices for calculating individualized doses (mg/kg) of each immunosuppressive drug increases the likelihood of achieving appropriate blood concentrations. However, the optimal weight index varies for each drug. Further studies, particularly those incorporating therapeutic drug monitoring (TDM) plans in transplant centers, are warranted to validate and generalize these findings, providing a potential avenue for improving immunosuppressive therapy and enhancing transplant outcomes.

[Sichuan Dark Tea-Based Medicated Dietary Formula Improves Obesity-Induced Renal Lipid Metabolism Disorder in Mice by Remodeling Gut Microbiota and Short-Chain Fatty Acid Metabolism]

Objective

To investigate the renoprotective effects of a Sichuan dark tea-based medicated dietary formula (alternatively referred to as Qing, or clarity in Chinese) on mice with diet-induced obesity (DIO) and to explore the specific mechanisms involved.

Methods

Male C57BL/6 mice were randomly assigned to three groups, a control group, a DIO group, and a Qing treatment group, or the Qing group, with 8 mice in each group. The mice in the control group were given normal maintenance feed and purified water, and the other two groups were fed a high-fat diet for 12 weeks to establish the DIO model. After that, high-fat diet continued in the DIO group, while the Qing group was given Qing at the same time for 12 weeks, during which period the weight of the mice was monitored and recorded every week. The mice were sacrificed after 12 weeks. Serum samples were collected and the levels of triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin were measured to evaluate liver function. In addition, renal lipids were extracted to determine the levels of TG and TC in the kidney and periodic acid-Schiff (PAS) and oil red O stainings were performed to evaluate kidney pathological injury. Western blot was performed to determine the phosphorylated AMPK (pAMPK)/AMPK ratio in the kidney tissue. RT-qPCR and Western blot were used to determine the expression of proteins related to fatty acid oxidation, including acetyl-CoA carboxylase 1 (ACC1), carnitine acyltransferase 1 (CTP1), peroxisome proliferators-activated receptor γ (PPARγ), peroxisome proliferators-activated receptor-1 α (PPAR1α), sterol-regulatory element binding proteins (SREBP-1), and key proteins related to lipid synthesis, including fatty acid synthase (FASN) and stearoyl-coenzyme A desaturase 1 (stearoyl-CoA desaturase) in the kidney tissue. 16SrRNA and metabolomics were applied to analyze the gut microbiota in the intestinal contents and its metabolites.

Results

Compared with those of the control group, the levels of liver mass (P=0.0003), serum ALT (P<0.0001) and AST (P=0.0001), and kidney TC (P=0.0191) and TG (P=0.0101) of the DIO group were significantly increased and there was lipid deposition in the kidney. Compared with those of the DIO group, mice in the Qing group showed effective reduction in liver mass (P=0.0316) and improvements in the abnormal serum levels of AST (P=0.0012) and ALT (P=0.0027) and kidney TC (P=0.0200) and TG (P=0.0499). In addition, mice in the Qing group showed significant improvement in lipid deposition in the kidney. Qing group showed increased pAMPK/AMPK ratio in comparison with that of the DIO group. In comparison with those of the control group, mice in the DIO group had upregulated expression of lipid synthesis-related genes and proteins (SREBP-1, FASN, and SCD1). As for the fatty acid oxidation-related genes and proteins, DIO mice showed upregulated expression of ACC1 and downregulated expression of CPT1A, PPARγ, and PGC1α in comparison with those of the control group. In the Qing goup, improvements in regard to all these changes were observed. The Qing group demonstrated improvement in the disrupted homeostasis of the gut microbiota. Short-chain fatty acids in the cecal contents, especially isovaleric acid and propionic acid, were also restored.

Conclusion

Sichuan dark tea-based medicated dietary formula may improve renal lipid metabolism by regulating gut microbiota and the levels of intestinal short-chain fatty acids, thereby protecting obesity-related kidney injury. Isovaleric acid and propionic acid may be the metabolites key to its regulation of gut microbiota.

Dioscorea nipponica Makino: A comprehensive review of its chemical composition and pharmacology on chronic kidney disease

Chronic kidney disease (CKD) is a widespread ailment that significantly impacts global health. It is characterized by high prevalence, poor prognosis, and substantial healthcare costs, making it a major public health concern. The current clinical treatments for CKD are not entirely satisfactory, leading to a high demand for alternative therapeutic options. Chinese herbal medicine, with its long history, diverse varieties, and proven efficacy, offers a promising avenue for exploration. One such Chinese herbal medicine, Dioscorea nipponica Makino (DNM), is frequently used to treat kidney diseases. In this review, we have compiled studies examining the mechanisms of action of DNM in the context of CKD, focusing on five primary areas: improvement of oxidative stress, inhibition of renal fibrosis, regulation of metabolism, reduction of inflammatory response, and regulation of autophagy.

Incidence of Kidney Stones After Bariatric Surgeries: Comparing Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

INTRODUCTION/PURPOSE

The two most common procedures performed to treat obesity are Roux-En-Y gastric bypass (RNYGB) and laparoscopic sleeve gastrectomy (LSG). Due to changes in enteric absorption, bariatric surgery increases rates of nephrolithiasis. As population-based data are limited, we aimed to compare the incidence of kidney stones after RNYGB and LSG.

MATERIALS AND METHODS

We queried Explorys (Cleveland, OH), a database that aggregated data from 26 healthcare systems. We identified patients who were newly diagnosed with nephrolithiasis 3, 6, and 12 months after their RNYGB or LSG. Additionally, a multivariate analysis was conducted to investigate the association of nephrolithiasis with RNYGB as compared to LSG. This analysis adjusted for other risk factors, including age above 65, male gender, Caucasian race, diabetes mellitus, hypertension, primary hyperparathyroidism, gout, and obesity.

RESULTS

From 1999 to 2019, there were 11,480 patients who underwent RNYGB and 22,770 patients who underwent LSG. The incidence of nephrolithiasis in the RNYGB cohort at all three time points was higher than in the LSG cohort (3 months, 7.1% vs. 2.4%; 6 months, 6.6% vs. 2.0%; 1 year, 5.8% vs. 1.4%; P < 0.001). After the multivariate analysis, it was found that, though both RNYGB and LSG were independently associated with the development of nephrolithiasis, the risk of nephrolithiasis was higher in those who underwent RNYGB compared to those who underwent LSG (OR 1.594, 95% CI 1.494 to 1.701, P < 0.001).

CONCLUSION

RNYGB is associated with a higher risk of nephrolithiasis when compared to LSG.

Glomerular hyperfiltration and hypertrophy: an evaluation of maximum values in pathological indicators to discriminate "diseased" from "normal"

The success of sodium-glucose cotransporter 2 inhibitors and bariatric surgery in patients with chronic kidney disease has highlighted the importance of glomerular hyperfiltration and hypertrophy in the progression of kidney disease. Sustained glomerular hyperfiltration and hypertrophy can lead to glomerular injury and progressive kidney damage. This article explores the relationship between obesity and chronic kidney disease, focusing on the roles of glomerular hyperfiltration and hypertrophy as hallmarks of obesity-related kidney disease. The pathological mechanisms underlying this association include adipose tissue inflammation, dyslipidemia, insulin resistance, chronic systemic inflammation, oxidative stress, and overactivation of the sympathetic nervous system, as well as the renin-angiotensin aldosterone system. This article explains how glomerular hyperfiltration results from increased renal blood flow and intraglomerular hypertension, inducing mechanical stress on the filtration barrier and post-filtration structures. Injured glomeruli increase in size before sclerosing and collapsing. Therefore, using extreme values, such as the maximal glomerular diameter, could improve the understanding of the data distribution and allow for better kidney failure predictions. This review provides important insights into the mechanisms underlying glomerular hyperfiltration and hypertrophy and highlights the need for further research using glomerular size, including maximum glomerular profile, calculated using needle biopsy specimens.

Glucagon-like peptide 1(GLP-1) receptor agonists in the management of the patient with type 2diabetes mellitus and chronic kidney disease: an approach for the nephrologist

Diabetic kidney disease, a common complication in patients with type 2 diabetes mellitus, is associated with a markedly increased morbidity and mortality, especially of cardiovascular origin, and faster progression to end-stage renal disease. To date, reducing cardiovascular and renal risk in this population was based on strict control of cardiovascular risk factors and the renin-angiotensin system blockade. More recently, sodium-glucose cotransporter type 2 inhibitors have demonstrated to offer cardiovascular and renal protection, but the residual risk remains high and their antihyperglycemic efficacy is limited in moderate-severe CKD. Therefore, drugs with a potent antihyperglycemic effect, independent of the glomerular filtration rate, with a low risk of hypoglycemia, that reduce weight in overweight/obese patients and that provide cardiovascular and renal protection, such as GLP-1 receptor agonists, are needed. However, these drugs require subcutaneous administration, which may limit their early use. The recent availability of oral semaglutide may facilitate the early introduction of this family with proven cardiovascular and renal benefits and excellent safety profile. In this review the family is analyzed as well as their cardiovascular and renal effects.

Change in circulating klotho in response to weight loss, with and without exercise, in adults with overweight or obesity

Introduction: Klotho is a protein associated with protection from aging-related diseases and health conditions. Obesity is associated with lower Klotho concentrations. Thus, this secondary analysis of adults with obesity examined 1) the change in serum Klotho concentration in response to a behavioral weight loss intervention by the magnitude of weight loss achieved; and 2) the association among serum Klotho concentration and weight, body composition, and cardiorespiratory fitness. Methods: Participants were randomized to either diet alone (DIET), diet plus 150 min of physical activity per week (DIET + PA150), or diet plus 250 min of physical activity per week (DIET + PA250). Participants [n = 152; age: 45.0 ± 7.9 years; body mass index (BMI): 32.4 ± 3.8 kg/m2] included in this secondary analysis provided blood samples at baseline, 6-, and 12 months, and were classified by weight loss response (Responder: achieved ≥10% weight loss at 6 or 12 months; Non-responder: achieved <5% weight loss at both 6 and 12 months). Serum Klotho was measured using a solid-phase sandwich enzyme-linked immunosorbent assay (ELISA). Analyses of covariance (ANCOVA's) were used to examine changes in weight, body composition, cardiorespiratory fitness, and Klotho concentration by weight loss response across the 12-month weight loss intervention. Results: Responders had a greater reduction in measures of weight and body composition, and a greater increase in cardiorespiratory fitness, compared to Non-Responders (p < 0.05). Change in Klotho concentration differed between Responders and Non-Responders (p < 0.05), with the increase in Klotho concentration from baseline to 6 months for Responders being statistically significant. The 6-month change in Klotho concentration was inversely associated with the 6-month change in weight (r s = -0.195), BMI (r s = -0.196), fat mass (r s = -0.184), and waist circumference (r s = -0.218) (p-values <0.05). Discussion: Findings provide evidence within the context of a behavioral intervention, with and without exercise, that change in Klotho concentration is significantly different between adults with weight loss ≥10% compared to <5% across 12 months. These findings suggest that weight loss and reduction in fat mass may be favorably associated with the change in Klotho concentration. This may reduce the risk of negative health consequences associated with accelerated aging in middle-aged adults.

The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review

Obesity is a worldwide epidemic that leads to several non-communicable illnesses, including chronic kidney disease (CKD). Diet and lifestyle modifications have shown a limited impact in the treatment of obesity. Because the group of end-stage renal disease (ESRD) patients examined in this study had limited access to kidney transplantation (KT), patients with obesity were thought to be at an increased risk of intraoperative and postoperative KT complications. Although bariatric surgery (BS) is now recognized as the gold standard treatment for morbid obesity, its role in ESRD or kidney transplant patients remains unknown. It is critical to know the correlation between weight loss and complications before and after KT, the impact of the overall graft, and patients' survival. Hence, this narrative review aims to present updated reports addressing when to perform surgery (before or after a KT), which surgical procedure to perform, and again, if strategies to avoid weight regain must be specific for these patients. It also analyzes the metabolic alterations produced by BS and studies its cost-effectiveness pre- and post-transplantation. Due to the better outcomes found in KT recipients, the authors consider it more convenient to perform BS before KT. However, more multicenter trials are required to provide a solid foundation for these recommendations in ERSD patients with obesity.

The Impact of Intraoperative Graft Blood Flow Measurement on Early Graft Function

BACKGROUND

The aim of this study is to evaluate the impact of intraoperative allograft vascular flow on early kidney graft function.

METHODS

A total of 159 patients underwent kidney transplantation from January 2017 to March 2022 at Linkou Chang Gung Memorial Hospital. Graft arterial and venous blood flow was measured separately with a transient time flowmeter (Transonic HT353; Transonic Systems, Inc, Ithaca, NY, United States) after ureteroneocystostomy. The early outcomes, including the postoperative creatinine level, were analyzed accordingly.

RESULTS

There were 83 males and 76 females, with a mean age of 44.5 years. The mean graft arterial flow measured was 480.6 mL/min, and the mean venous flow was 506.2 mL/min. Delayed graft function (DGF) incidence was 36.5%, 32.5%, and 40.8% in total, living, and deceased donor groups, respectively. Living donor and deceased donor kidney transplantation were analyzed separately. In the DGF subgroup, there were lower graft venous flows, higher body mass index (BMI), and more male patients in the living kidney transplant group. Similarly, the deceased donor kidney transplantation group with delayed graft function tended to have higher body height, higher body weight, higher BMI, and more diabetes mellitus. The multivariate analysis showed that lower graft venous blood flow (odds ratio [OR] = 0.995, P = .008) and higher BMI (OR = 1.144, P = .042) were significantly correlated with delayed graft function in living donor kidney transplantations. In the deceased donor group, a multivariate analysis of risk factors showed that BMI had a significant correlation with delayed graft function (OR = 1.41, P = .039).

CONCLUSIONS

Graft venous blood flow was significantly associated with delayed graft function in living donor kidney transplantation, and high BMI was correlated with DGF in all patients receiving kidney transplantation.

Long-term Evolution of Estimated Glomerular Filtration Rate in Patients With Antiviral Treatment for Hepatitis C Virus Infection

BACKGROUND & AIMS

Data regarding the long-term evolution of estimated glomerular filtration rate (eGFR) in patients receiving antiviral treatment for hepatitis C virus are limited.

METHODS

A total of 1987 patients with eGFR ≥15 mL/min/1.73m2 who received interferon or direct-acting antiviral treatment were prospectively enrolled in this cohort study. The eGFR was assessed biannually by the Chronic Kidney Disease Epidemiology Collaboration equation from the time point of sustained virologic response (SVR12). Multivariate generalized estimated equation was used to assess the association between the factors of interest and evolution of eGFR following antiviral treatment. Multivariate Cox regression analysis was used to assess the relative risk of end-stage renal disease (ESRD), defined as an eGFR <15 mL/min/1.73m2.

RESULTS

Patients who achieved SVR12 (adjusted slope coefficient difference: 2.36 mL/min/1.73 m2/year; 95% confidence interval [CI], 1.50 to 3.32; P < .001) were associated with eGFR improvement, compared with those who did not achieve SVR12. Among patients who achieved SVR12, the eGFR evolution was comparable (adjusted slope coefficient difference: 0.31 mL/min/1.73m2/year; 95% CI, -0.34 to 0.96; P = .35) in those treated with interferon or direct-acting antiviral. The incidence rates of ESRD in patients who achieved and did not achieve SVR12 were 0.06 per 100 person-years and 0.37 per 100 person-years. Patients who achieved SVR12 were associated with a lower risk of ESRD (adjusted hazard ratio, 0.24; 95% CI, 0.05-0.68; P = .021).

CONCLUSIONS

The long-term eGFR evolution and risk of ESRD are significantly improved in patients who achieve SVR12 with anti- hepatitis C virus treatment.

Association between low handgrip strength and obesity with mortality in peritoneal dialysis patients

The association between sarcopenia and obesity in peritoneal dialysis (PD) patients is more complex than that of the general population. The aim of this study was, therefore, to evaluate the association of patient survival with sarcopenia or sarcopenic components and obesity in groups of patients with PD. We retrospectively analyzed a dataset from 199 prevalent PD patients. Measurements including handgrip strength (HGS), appendicular lean mass index, and baseline characteristics, were obtained during the period of study. Patients were divided into four groups according to their HGS and obesity: NH-NO (normal HGS and non-obesity, n = 60), NH-O (normal HGS and obesity, n = 31), LH-NO (low HGS and non-obesity, n = 71), and LH-O (low HGS and obesity, n = 37). The median follow-up interval was 17 months. The Kaplan-Meier curve analysis showed that the LH-O group had the poorest patient survival outcome among the four groups (P < 0.001). The NH-NO group had a better patient survival outcome compared with the LH-NO group. Univariate and multivariate Cox regression analyses showed that the LH-O group had the highest mortality rate compared with the other groups. The NH-NO group had lower mortality compared with the LH-NO group. The present study demonstrated that obesity with low HGS was associated with the greatest mortality rate in groups defined by HGS and obesity.

Obesity and renal disease: Benefits of bariatric surgery

The prevalence of obesity, a preventable and reversible condition with a high impact on health, continues to rise, especially after the COVID-19 pandemic. Severe overweight is well recognized as a risk factor for diabetes and hypertension, among other conditions, that may increase cardiovascular risk. Obesity has grown simultaneously with a rise in the prevalence of chronic kidney disease, and a pathophysiological link has been established, which explains its role in generating the conditions to facilitate the emergence and maximize the impact of the risk factors of chronic kidney disease and its progression to more advanced stages. Knowing the mechanisms involved and having different tools to reverse the overweight and its consequences, bariatric surgery has arisen as a useful and efficient method, complementary or alternative to others, such as lifestyle changes and/or pharmacotherapy. In a detailed review, the mechanisms involved in the renal consequences of obesity, the impact on risk factors, and the potential benefit of bariatric surgery at different stages of the disease and its progression are exposed and analyzed. Although the observational evidence supports the value of bariatric surgery as a renoprotective measure in individuals with obesity, diabetic or not, randomized studies are expected to establish evidence-based recommendations that demonstrate its positive risk-benefit balance as a complementary or alternative therapeutic tool.

A Simple and Portable Personal Glucose Meter Method Combined with Molecular Docking for Screening of Lipase Inhibitors

With the increase of obesity incidence, the development of antiobesity drugs has aroused extensive interest. In this study, a simple and portable personal glucose meter (PGM) method based on the lipase-mediated reaction combined with molecular docking was developed for the screening of lipase inhibitors. Lipase can catalyse the hydrolysis of 4-acetamidophenyl acetate to form acetaminophen, which can directly trigger the reduction of K3[Fe(CN)6] to K4[Fe(CN)6] in the glucose test strips and generate an electrical signal that can be detected by the PGM. When lipase inhibitors exist, the yield of acetaminophen will be reduced and results in a corresponding decrease of the PGM signal. Therefore, the activity of lipase can be measured by the PGM. After optimization of the experimental conditions, the inhibitory activity of fourteen small-molecule compounds and fifteen natural product extracts on lipase were evaluated by the developed PGM method. The results indicate that tannic acid, (-)-epigallocatechin gallate, (-)-epigallocatechin, (-)-epicatechin gallate, and epicatechin have good inhibitory effect on lipase (% of inhibition higher than 40.0%). Besides, the natural product extracts of Galla Chinensis, lemon, and Rhei Radix et Rhizoma have a good inhibitory effect on lipase with % of inhibition of (97.5 ± 0.6)%, (88.1 ± 0.7)%, and (79.1 ± 1.6)%, respectively. Finally, the binding sites and modes of six small-molecule compounds on lipase were investigated by the molecular docking study. The results show that the developed PGM method is an effective approach for the discovery of potential lipase inhibitors.

Novel Insights in the Physiopathology and Management of Obesity-Related Kidney Disease

Obesity is recognized as an independent risk factor for the development of kidney disease, which has led to the designation of obesity-related glomerulopathy (ORG). Common renal features observed in this condition include glomerular hypertrophy, glomerulosclerosis, haemodynamic changes and glomerular filtration barrier defects. Additionally, and although less studied, obesity-related kidney disease also involves alterations in renal tubules, including tubule hypertrophy, lipid deposition and tubulointerstitial fibrosis. Although not completely understood, the harmful effects of obesity on the kidney may be mediated by different mechanisms, with alterations in adipose tissue probably playing an important role. An increase in visceral adipose tissue has classically been associated with the development of kidney damage, however, recent studies point to adipose tissue surrounding the kidney, and specifically to the fat within the renal sinus, as potentially involved in the development of ORG. In addition, new strategies for the treatment of patients with obesity-related kidney disease are focusing on the management of obesity. In this regard, some non-invasive options, such as glucagon-like peptide-1 (GLP-1) receptor agonists or sodium–glucose cotransporter-2 (SGLT2) inhibitors, are being considered for application in the clinic, not only for patients with diabetic kidney disease but as a novel pharmacological strategy for patients with ORG. In addition, bariatric surgery stands as one of the most effective options, not only for weight loss but also for the improvement of kidney outcomes in obese patients with chronic kidney disease.

Changes in interstitial cells and gastric excitability in a mouse model of sleeve gastrectomy

Obesity is a critical risk factor of several life-threatening diseases and the prevalence in adults has dramatically increased over the past ten years. In the USA the age-adjusted prevalence of obesity in adults was 42.4%, i.e., with a body mass index (BMI, weight (kg)/height (m)2) that exceeds 30 kg/m2. Obese individuals are at the higher risk of obesity-related diseases, co-morbid conditions, lower quality of life, and increased mortality more than those in the normal BMI range i.e., 18.5-24.9 kg/m2. Surgical treatment continues to be the most efficient and scientifically successful treatment for obese patients. Sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a relatively new gastric procedure to reduce body weight but is now the most popular bariatric operation. To date there have been few studies examining the changes in the cellular components and pacemaker activity that occur in the gastric wall following VSG and whether normal gastric activity recovers following VSG. In the present study we used a murine model to investigate the chronological changes of gastric excitability including electrophysiological, molecular and morphological changes in the gastric musculature following VSG. There is a significant disruption in specialized interstitial cells of Cajal in the gastric antrum following sleeve gastrectomy. This is associated with a loss of gastric pacemaker activity and post-junctional neuroeffector responses. Over a 4-month recovery period there was a gradual return in interstitial cells of Cajal networks, pacemaker activity and neural responses. These data describe for the first time the changes in gastric interstitial cells of Cajal networks, pacemaker activity and neuroeffector responses and the time-dependent recovery of ICC networks and normalization of motor activity and neural responses following VSG.