Vestersager SV. et al., 2025: Low-intensity extracorporeal shockwave therapy in patients with diabetic kidney disease: a matched cohort study.

Monday, 30 June 2025

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Sofus Valentin Vestersager 1, Sune Moeller Skov-Jeppesen 2, Knud Bonnet Yderstraede 3 4, Claus Bistrup 4 5, Boye L Jensen 6, Lars Lund 7 8 9
1Department of Urology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
2Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
3Steno Diabetes Center, Odense University Hospital, Odense, Denmark.
4Clinical Institute, University of Southern Denmark, Odense, Denmark.
5Department of Nephrology, Odense University Hospital, Odense, Denmark.
6Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
7Department of Urology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
8Steno Diabetes Center, Odense University Hospital, Odense, Denmark.
9Clinical Institute, University of Southern Denmark, Odense, Denmark.

Abstract

Purpose: Low-intensity extracorporeal shockwave therapy (LI-ESWT) is a potential novel treatment against diabetic kidney disease (DKD). The present study investigates the longer term effects of LI-ESWT on kidney function in patients with DKD.

Methods: This matched cohort study included 28 patients with DKD, who received six sessions of LI-ESWT. Patients were matched 1:5 with patients from the Funen Diabetes Database. Multivariable adjusted eGFR and ACR were analyzed using multilevel mixed-effects linear regression. The primary outcomes were ACR and eGFR measured at 3, 6, 12, and 18 month follow-up. Secondary analyses with patients stratified for sex, age, baseline eGFR, and baseline ACR were made for the multivariable adjusted values of eGFR and ACR.

Results: No significant difference in multivariable adjusted ACR or eGFR was found at 18 months. The intervention group showed a non-significant decrease in adjusted eGFR (1.83 mL/min/1.73 m2 lower, p = 0.15) and ACR (14%, p = 0,56). Stratified results revealed lower eGFR in patients > 60 years 3.64 mL/min/1.73 m2, p = 0.03) and those with baseline ACR ≤ 300 mg/g (3.64 mL/min/1.73, p = 0.007).

Conclusion: LI-ESWT did not demonstrate overall statistically significant effects on eGFR and ACR at 3, 6, 12, or 18 months. However, secondary analyses suggest possible effects in certain subgroups. Clinical studies with larger samples are needed to clarify the efficacy of LI-ESWT in specific DKD patient subgroups. Trial Registration The trial was prospectively registered July 31, 2015, at ClinicalTrials.gov with registration number NCT02515461.

Int Urol Nephrol. 2025 Feb 12. doi: 10.1007/s11255-025-04379-4. Online ahead of print.
PMID: 39934556

Comments 1

Jens Rassweiler on Monday, 30 June 2025 11:00

The article discusses a matched cohort study investigating the effects of low-intensity extracorporeal shockwave therapy (LI-ESWT) on diabetic kidney disease (DKD) in patients with chronic kidney disease (CKD) stage 3. The study addresses the increasing incidence of diabetes mellitus (DM) and its complications, particularly DKD, which is a major cause of end-stage renal disease (ESRD).

Background: The prevalence of diabetes is expected to rise, with many patients developing chronic kidney disease over their lifetime. Current treatments for DKD include various medications that improve kidney outcomes but have not completely mitigated the risk of progressing to ESRD, necessitating new therapeutic options. The study aimed to evaluate the longer-term effects of LI-ESWT on kidney function, specifically looking at glomerular filtration rate (eGFR) and urinary-albumin creatinine ratio (ACR) over 18 months.

Methodology: The study involved a matched cohort design, comparing patients who received LI-ESWT at Odense University Hospital with control patients from the Funen Diabetes Database (FDDB). The treatment involved six sessions of LI-ESWT directed at the kidneys, with specific protocols for energy levels and shock delivery. Using the Modulith SLX-2 each kidney received 1000 shocks at the upper pole, middle part, and lower pole, respectively. The first 200 shocks in each part of the kidney were given with gradually increasing energy levels, starting at 0.136 mJ/mm2 and increasing to 0.265 mJ/mm2. The remaining 800 shocks were given at 0.265 mJ/mm2. The shockwaves were administered with a frequency of 4 Hz and extended focal zone. Each patient received six treatment sessions over a period of 3 weeks, with a 3–4 day-interval between each session.

Results: No significant differences were found between the intervention and control groups regarding eGFR and ACR at baseline or during follow-ups at 3, 6, 12, and 18 months. The unadjusted eGFR and ACR values between the two groups exhibited patterns of lower kidney function and higher albumin levels in the LI-ESWT group, but these differences were not statistically significant. Stratified analyses indicated that in patients over 60 years old and those with lower baseline ACRs (less equal 300 mg/g), the intervention group had lower eGFR at follow-up, suggesting a potential slower progression toward end-stage kidney disease under specific conditions.
Conclusion: The study concluded that LI-ESWT did not produce significant differences in kidney function outcomes compared to the control group. However, the observed trends could warrant further investigation, particularly in specific patient subgroups: LI-ESWT may have a beneficial effect on urinary- albumin creatinine ratio (ACR), although larger studies may be needed to clarify its role in lowering ACR. Overall, while the findings did not demonstrate a definitive benefit of LI-ESWT in improving kidney function in DKD patients, the study paves the way for additional research on the therapy, especially for different demographics within CKD populations. Thus, so far the promising results of previous animal studies could not be confirmed in a clinical setting.

Jens Rassweiler

Background: The prevalence of diabetes is expected to rise, with many patients developing chronic kidney disease over their lifetime. Current treatments for DKD include various medications that improve kidney outcomes but have not completely mitigated the risk of progressing to ESRD, necessitating new therapeutic options. The study aimed to evaluate the longer-term effects of LI-ESWT on kidney function, specifically looking at glomerular filtration rate (eGFR) and urinary-albumin creatinine ratio (ACR) over 18 months.

Methodology: The study involved a matched cohort design, comparing patients who received LI-ESWT at Odense University Hospital with control patients from the Funen Diabetes Database (FDDB). The treatment involved six sessions of LI-ESWT directed at the kidneys, with specific protocols for energy levels and shock delivery. Using the Modulith SLX-2 each kidney received 1000 shocks at the upper pole, middle part, and lower pole, respectively. The first 200 shocks in each part of the kidney were given with gradually increasing energy levels, starting at 0.136 mJ/mm2 and increasing to 0.265 mJ/mm2. The remaining 800 shocks were given at 0.265 mJ/mm2. The shockwaves were administered with a frequency of 4 Hz and extended focal zone. Each patient received six treatment sessions over a period of 3 weeks, with a 3–4 day-interval between each session.

Results: No significant differences were found between the intervention and control groups regarding eGFR and ACR at baseline or during follow-ups at 3, 6, 12, and 18 months. The unadjusted eGFR and ACR values between the two groups exhibited patterns of lower kidney function and higher albumin levels in the LI-ESWT group, but these differences were not statistically significant. Stratified analyses indicated that in patients over 60 years old and those with lower baseline ACRs (less equal 300 mg/g), the intervention group had lower eGFR at follow-up, suggesting a potential slower progression toward end-stage kidney disease under specific conditions.
Conclusion: The study concluded that LI-ESWT did not produce significant differences in kidney function outcomes compared to the control group. However, the observed trends could warrant further investigation, particularly in specific patient subgroups: LI-ESWT may have a beneficial effect on urinary- albumin creatinine ratio (ACR), although larger studies may be needed to clarify its role in lowering ACR. Overall, while the findings did not demonstrate a definitive benefit of LI-ESWT in improving kidney function in DKD patients, the study paves the way for additional research on the therapy, especially for different demographics within CKD populations. Thus, so far the promising results of previous animal studies could not be confirmed in a clinical setting.

Jens Rassweiler

The article discusses a matched cohort study investigating the effects of low-intensity extracorporeal shockwave therapy (LI-ESWT) on diabetic kidney disease (DKD) in patients with chronic kidney disease (CKD) stage 3. The study addresses the increasing incidence of diabetes mellitus (DM) and its complications, particularly DKD, which is a major cause of end-stage renal disease (ESRD). Background: The prevalence of diabetes is expected to rise, with many patients developing chronic kidney disease over their lifetime. Current treatments for DKD include various medications that improve kidney outcomes but have not completely mitigated the risk of progressing to ESRD, necessitating new therapeutic options. The study aimed to evaluate the longer-term effects of LI-ESWT on kidney function, specifically looking at glomerular filtration rate (eGFR) and urinary-albumin creatinine ratio (ACR) over 18 months. Methodology: The study involved a matched cohort design, comparing patients who received LI-ESWT at Odense University Hospital with control patients from the Funen Diabetes Database (FDDB). The treatment involved six sessions of LI-ESWT directed at the kidneys, with specific protocols for energy levels and shock delivery. Using the Modulith SLX-2 each kidney received 1000 shocks at the upper pole, middle part, and lower pole, respectively. The first 200 shocks in each part of the kidney were given with gradually increasing energy levels, starting at 0.136 mJ/mm2 and increasing to 0.265 mJ/mm2. The remaining 800 shocks were given at 0.265 mJ/mm2. The shockwaves were administered with a frequency of 4 Hz and extended focal zone. Each patient received six treatment sessions over a period of 3 weeks, with a 3–4 day-interval between each session. Results: No significant differences were found between the intervention and control groups regarding eGFR and ACR at baseline or during follow-ups at 3, 6, 12, and 18 months. The unadjusted eGFR and ACR values between the two groups exhibited patterns of lower kidney function and higher albumin levels in the LI-ESWT group, but these differences were not statistically significant. Stratified analyses indicated that in patients over 60 years old and those with lower baseline ACRs (less equal 300 mg/g), the intervention group had lower eGFR at follow-up, suggesting a potential slower progression toward end-stage kidney disease under specific conditions. Conclusion: The study concluded that LI-ESWT did not produce significant differences in kidney function outcomes compared to the control group. However, the observed trends could warrant further investigation, particularly in specific patient subgroups: LI-ESWT may have a beneficial effect on urinary- albumin creatinine ratio (ACR), although larger studies may be needed to clarify its role in lowering ACR. Overall, while the findings did not demonstrate a definitive benefit of LI-ESWT in improving kidney function in DKD patients, the study paves the way for additional research on the therapy, especially for different demographics within CKD populations. Thus, so far the promising results of previous animal studies could not be confirmed in a clinical setting. Jens Rassweiler

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