Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT) in Renal Diseases: A Review of Animal and Human Studies

Overview

Journal Int J Nephrol Renovasc Dis

Publisher Dove Medical Press

Specialty Nephrology

Date 2023 Feb 13

PMID 36778197

Authors

Sune Moeller Skov-Jeppesen

Nicky Anuel Petersen

Knud Bonnet Yderstraede

Boye L Jensen

Claus Bistrup

Lars Lund

Affiliations

Soon will be listed here.

Abstract

Background: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has been suggested as a treatment for vascular diseases such as ischemic heart disease, diabetic foot ulcers, and erectile dysfunction. Primarily, LI-ESWT is known for its ability to stimulate angiogenesis and activation of stem cells in target tissues. Application of LI-ESWT in chronic progressive renal diseases is a novel area. The aim of the present review was to summarize available data on the effects of LI-ESWT used in the setting of renal diseases.

Methods: We systematically searched PubMed, Medline, and Embase databases for relevant studies. Our review included the results from preclinical animal experiments and clinical research.

Results: Eleven animal studies and one clinical study were included in the review. In the animal studies, LI-ESWT was used for the treatment of hypertensive nephropathy (n=1), diabetic nephropathy (n=1), or various types of ischemic renal injury (ie, artery occlusion, reperfusion injury) (n=9). The clinical study was conducted in a single-arm cohort as a Phase 1 study with patients having diabetic nephropathy. In animal studies, the application of LI-ESWT was associated with several effects: LI-ESWT led to increased VEGF and endothelial cell proliferation and improved vascularity and perfusion of the kidney tissue. LI-ESWT reduced renal inflammation and fibrosis. LI-ESWT caused only mild side effects in the clinical study, and, similarly, there were no signs of kidney injury after LI-ESWT in the animal studies.

Conclusion: LI-ESWT, as a non-invasive treatment, reduces the pathological manifestations (inflammation, capillary rarefaction, fibrosis, decreased perfusion) associated with certain types of renal disease. The efficacy of renal LI-ESWT needs to be confirmed in randomized clinical trials.

Citing Articles

Low-intensity extracorporeal shockwave therapy in patients with diabetic kidney disease: a matched cohort study.

Vestersager S, Skov-Jeppesen S, Yderstraede K, Bistrup C, Jensen B, Lund L Int Urol Nephrol. 2025; .

PMID: 39934556 DOI: 10.1007/s11255-025-04379-4.

References

Yan X, Zeng B, Chai Y, Luo C, Li X . Improvement of blood flow, expression of nitric oxide, and vascular endothelial growth factor by low-energy shockwave therapy in random-pattern skin flap model. Ann Plast Surg. 2008; 61(6):646-53. DOI: 10.1097/SAP.0b013e318172ba1f. View

Kamelger F, Oehlbauer M, Piza-Katzer H, Meirer R . Extracorporeal shock wave treatment in ischemic tissues: what is the appropriate number of shock wave impulses?. J Reconstr Microsurg. 2009; 26(2):117-21. DOI: 10.1055/s-0029-1243296. View

Fu M, Sun C, Lin Y, Wang C, Wu C, Ko S . Extracorporeal shock wave therapy reverses ischemia-related left ventricular dysfunction and remodeling: molecular-cellular and functional assessment. PLoS One. 2011; 6(9):e24342. PMC: 3167851. DOI: 10.1371/journal.pone.0024342. View

Sung P, Chen K, Li Y, Chiang J, Lee M, Yip H . Sitagliptin and shock wave-supported peripheral blood derived endothelial progenitor cell therapy effectively preserves residual renal function in chronic kidney disease in rat-role of dipeptidyl peptidase 4 inhibition. Biomed Pharmacother. 2019; 111:1088-1102. DOI: 10.1016/j.biopha.2019.01.025. View

Cayton T, Harwood A, Smith G, Chetter I . A Systematic Review of Extracorporeal Shockwave Therapy as a Novel Treatment for Intermittent Claudication. Ann Vasc Surg. 2016; 35:226-33. DOI: 10.1016/j.avsg.2016.02.017. View

Cai H, Li L, Guo T, Wang Y, Ma T, Xiao J . Cardiac shockwave therapy improves myocardial function in patients with refractory coronary artery disease by promoting VEGF and IL-8 secretion to mediate the proliferation of endothelial progenitor cells. Exp Ther Med. 2015; 10(6):2410-2416. PMC: 4665829. DOI: 10.3892/etm.2015.2820. View

Huang Q, Yan P, Xiong H, Shuai T, Liu J, Zhu L . Extracorporeal Shock Wave Therapy for Treating Foot Ulcers in Adults With Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Can J Diabetes. 2019; 44(2):196-204.e3. DOI: 10.1016/j.jcjd.2019.05.006. View

Chen X, Zhang X, Jiang K, Krier J, Zhu X, Lerman A . Improved renal outcomes after revascularization of the stenotic renal artery in pigs by prior treatment with low-energy extracorporeal shockwave therapy. J Hypertens. 2019; 37(10):2074-2082. PMC: 7304646. DOI: 10.1097/HJH.0000000000002158. View

Caron J, Michel P, Dussaule J, Chatziantoniou C, Ronco P, Boffa J . Extracorporeal shock wave therapy does not improve hypertensive nephropathy. Physiol Rep. 2016; 4(11). PMC: 4908482. DOI: 10.14814/phy2.12699. View

10.

Jeong H, Jeon S, Guan Qun Z, Kim K, Choi S, Bashraheel F . Effects of Next-Generation Low-Energy Extracorporeal Shockwave Therapy on Erectile Dysfunction in an Animal Model of Diabetes. World J Mens Health. 2017; 35(3):186-195. PMC: 5746490. DOI: 10.5534/wjmh.17024. View

11.

Mittermayr R, Hartinger J, Antonic V, Meinl A, Pfeifer S, Stojadinovic A . Extracorporeal shock wave therapy (ESWT) minimizes ischemic tissue necrosis irrespective of application time and promotes tissue revascularization by stimulating angiogenesis. Ann Surg. 2011; 253(5):1024-32. DOI: 10.1097/SLA.0b013e3182121d6e. View

12.

Wang C, Ko J, Kuo Y, Yang Y . Molecular changes in diabetic foot ulcers. Diabetes Res Clin Pract. 2011; 94(1):105-10. DOI: 10.1016/j.diabres.2011.06.016. View

13.

Lei P, Tao S, Shuai Q, Bao Y, Wang S, Qu Y . Extracorporeal cardiac shock wave therapy ameliorates myocardial fibrosis by decreasing the amount of fibrocytes after acute myocardial infarction in pigs. Coron Artery Dis. 2013; 24(6):509-15. DOI: 10.1097/MCA.0b013e3283640ec7. View

14.

Holfeld J, Tepekoylu C, Blunder S, Lobenwein D, Kirchmair E, Dietl M . Low energy shock wave therapy induces angiogenesis in acute hind-limb ischemia via VEGF receptor 2 phosphorylation. PLoS One. 2014; 9(8):e103982. PMC: 4122398. DOI: 10.1371/journal.pone.0103982. View

15.

Wang C, Wu R, Yang Y . Treatment of diabetic foot ulcers: a comparative study of extracorporeal shockwave therapy and hyperbaric oxygen therapy. Diabetes Res Clin Pract. 2011; 92(2):187-93. DOI: 10.1016/j.diabres.2011.01.019. View

16.

Holfeld J, Tepekoylu C, Reissig C, Lobenwein D, Scheller B, Kirchmair E . Toll-like receptor 3 signalling mediates angiogenic response upon shock wave treatment of ischaemic muscle. Cardiovasc Res. 2015; 109(2):331-43. DOI: 10.1093/cvr/cvv272. View

17.

Kaller M, Faber L, Bogunovic N, Horstkotte D, Burchert W, Lindner O . Cardiac shock wave therapy and myocardial perfusion in severe coronary artery disease. Clin Res Cardiol. 2015; 104(10):843-9. PMC: 4580718. DOI: 10.1007/s00392-015-0853-0. View

18.

Yoshida M, Nakamichi T, Mori T, Ito K, Shimokawa H, Ito S . Low-energy extracorporeal shock wave ameliorates ischemic acute kidney injury in rats. Clin Exp Nephrol. 2019; 23(5):597-605. DOI: 10.1007/s10157-019-01689-7. View

19.

Abe Y, Ito K, Hao K, Shindo T, Ogata T, Kagaya Y . Extracorporeal low-energy shock-wave therapy exerts anti-inflammatory effects in a rat model of acute myocardial infarction. Circ J. 2014; 78(12):2915-25. DOI: 10.1253/circj.cj-14-0230. View

20.

Jeppesen S, Yderstraede K, Rasmussen B, Hanna M, Lund L . Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers: a prospective randomised trial. J Wound Care. 2016; 25(11):641-649. DOI: 10.12968/jowc.2016.25.11.641. View