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Introduction

Beside well characterized short term adverse effects of extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stones, concerns regarding long term adverse effects to the kidneys or adjacent organs (e.g. pancreas) were raised. We aimed to analyze whether ESWL applied to the kidneys is associated with decreased kidney function, hypertension or diabetes during long term follow-up.

Methods

All patients with urolithiasis treated by ESWL at our tertiary care center between 1992 and 2013 were retrospectively identified. Cases consisted of patients treated by ESWL because of kidney stones (kidney group). Patients with distal ureter stones treated by ESWL served as a control group. Patients treated by ESWL for upper or middle ureter stones or patients treated for both, kidney and distal ureter stones were excluded. In 2016, a questionnaire was sent to all patients to assess the prevalence of decreased kidney function, hypertension and diabetes. The Swiss Health Survey data set (n=21,597) providing population data for hypertension and diabetes but not decreased kidney function was used as an additional comparison group.

Results

Of 7108 identified patients, 2,776 (39%) met the inclusion criteria. Follow-up questionnaires were returned by 764 (28%) patients of which 585 (77%) questionnaires belonged to the kidney group, and 179 (23%) to the distal ureter group. Median time between first ESWL and returned questionnaire was 12 years (8-18 years) for the kidney group and 16 years (IQR 11-20 years) for the control group._x000D_ There was no significant difference between the kidney group and the control group regarding age (mean 62+-14 vs. 64+-14, p=0.252), gender (female 34% vs. 28%, p=0.123) and BMI (mean 26+-4 vs. 26+-4, p=0.687). However, in the kidney group more number of ESWL sessions were observed compared to the control group (1 [IQR 1-2] vs. 1 [IQR 1-1], p<0.001). Furthermore the prevalence of decreased kidney function in the kidney group was significantly higher compared to the control group (8.3% vs. 2.9%, p=0.015). The kidney group, control group and general population showed significant differences regarding prevalence of hypertension (47.5% vs. 49.4% vs. 27.5%, p<0.001) and diabetes (14.1% vs. 11.9% vs. 4.9%, p<0.001)._x000D_ In multivariable regression analyses controlling for age, gender and BMI, number of applied ESWL sessions to the kidneys was an independent predictor for decreased kidney function (OR 1.28, 95% CI 1.010 to 1.623, p=0.041) but not for hypertension or diabetes._x000D_

Conclusions

ESWL for renal stones may lead to decreased kidney function during long term follow-up. The association between increasing number of applied ESWL sessions and decreased kidney function at long-term follow-up supports a causal relationship.

Funding

none