From the Guidelines
Leg cramps during dialysis can be effectively managed by adjusting the dialysate sodium concentration, switching to a bicarbonate-buffered dialysate, and reducing the dialysate temperature, as these interventions have been shown to minimize intradialytic hypotension and cramps 1. To reduce cramping, several approaches can be taken.
- Adjusting the dialysate solute concentration, such as increasing the dialysate sodium concentration (148 mEq/L) and using a "sodium ramping" technique, can help ameliorate intradialytic hypotension and cramps 1.
- Converting from an acetate-containing dialysate to a bicarbonate-containing dialysate can also minimize hypotension and cramps, while reducing headaches, nausea, and vomiting 1.
- Reducing the dialysate temperature from 37°C to 34-35°C can increase peripheral vasoconstriction and cardiac output, thereby reducing the occurrence of hypotension and accompanying symptoms 1. Additionally, strategies such as avoiding excessive ultrafiltration, slowing the ultrafiltration rate, and correcting anemia can help minimize intradialytic symptoms, including cramps 1. It is essential to work with a dialysis team to adjust the dialysis prescription and implement these interventions to reduce cramping and improve overall dialysis outcomes.
- Maintaining proper electrolyte balance, taking prescribed medications, and engaging in regular exercise and proper nutrition can also support muscle health and reduce cramping frequency.
- If cramps persist despite these measures, it is crucial to discuss with a nephrologist, as they may indicate other issues requiring attention.
From the Research
Causes and Prevention of Cramping in Legs during Dialysis
- Cramping in legs during dialysis is a common cause of morbidity in end-stage renal disease patients on maintenance hemodialysis 2.
- The exact cause of cramping is not well-defined, but it is thought to be related to stagnant venous flow during dialysis 2.
- Sequential compression devices (SCD) have been shown to improve venous return and prevent leg cramps in some patients 2.
Treatment Options for Cramping in Legs during Dialysis
- Quinine sulfate has been used to treat muscle cramps in dialysis patients, but its use is limited due to potential toxicity 3, 4.
- Vitamin E has been shown to be effective in reducing the frequency and severity of leg cramps in dialysis patients 3, 5.
- Other potential alternative agents for treating leg cramps include verapamil, gabapentin, carisoprodol, and orphenadrine 6.
Efficacy of Treatment Options
- A study found that quinine and vitamin E were effective in reducing the frequency and severity of leg cramps in dialysis patients, with similar efficacy between the two treatments 3.
- A controlled trial found that supplementary vitamin E led to a 68.3% reduction in muscle cramps in hemodialysis patients 5.
- The efficacy of quinine in treating leg cramps is questionable due to poor quality data and a well-known toxicity profile 6.