Muscle Cramps in Hemodialysis Patients

Muscle cramps occur in 33 to 86% of patients with end stage renal disease (ESRD) during hemodialysis (HD) and often lead to early termination of HD sessions and are therefore of significant cause of inadequate dialysis among these patients. They usually involve the muscles of the lower extremity, but other muscles including hands, arms, and abdomen may also be affected. Although, the exact etiology of cramps during HD is unknown, however changes in plasma osmolality, extracellular fluid volume depletion, tissue hypoxia, hypomagnesaemia and carnitine deficiency have been implicated. Treatment of dialysis-associated cramps is directed at two goals: prevention or at least reducing the frequency of cramps and relieving symptoms when they occur.  Minimization of inter-dialysis weight gains, increasing dialysis treatment time to reduce ultrafiltration rate, prevention of dialysis-associated hypotension and the use of high concentrations of sodium in the dialysate, carnitine supplementation, and administration of gabapentin may prevent or at least reduce the number of attacks of muscle cramps. For relieving symptoms, administration of hypertonic saline and or 50% dextrose are equally effective; however hypertonic dextrose may be the preferred option among those HD patients without diabetes.