What causes muscle spasms in patients with Chronic Kidney Disease (CKD)?

From the Guidelines

Muscle spasms in patients with chronic kidney disease (CKD) should be managed by identifying and correcting underlying electrolyte abnormalities, and medication options such as baclofen (10 mg/day, with a weekly increase of 10 mg/day up to 30 mg/day) can be effective in relieving symptoms 1.

Treatment Approach

When managing muscle spasms in CKD patients, it is essential to consider the potential causes, including electrolyte imbalances, particularly low calcium, magnesium, and potassium levels. Regular blood tests can help identify these imbalances, and correction of these abnormalities is crucial for effective management.

• Gentle stretching and applying heat to the affected muscles can provide immediate relief.
• Medication options, such as baclofen, can be effective in relieving muscle spasms, with a recommended dose of 10 mg/day, increasing weekly by 10 mg/day up to 30 mg/day 1.
• Other medications, such as orphenadrine and methocarbamol, have also been proposed for muscle cramps in patients with cirrhosis, but their use in CKD patients requires careful consideration of potential side effects and interactions 1.

Considerations in CKD Patients

CKD patients often experience disruptions in normal mineral metabolism and acid-base balance, leading to neuromuscular irritability and muscle spasms.

• Maintaining adequate hydration without overloading, following a kidney-friendly diet, and engaging in regular gentle exercise as tolerated are essential for managing muscle spasms in CKD patients.
• Dialysis patients may experience muscle cramps during treatment due to rapid fluid and electrolyte shifts, which can be managed by adjusting the dialysis prescription and providing intradialytic treatments like hypertonic saline or glucose solutions when necessary.

Evidence-Based Recommendations

The most recent and highest quality study on muscle spasms in CKD patients is not directly available, but a study on ascites management provides insights into the use of medications like baclofen for muscle cramps 1.

• While a study on parathyroidectomy for secondary hyperparathyroidism in chronic renal failure provides information on the management of electrolyte imbalances and mineral metabolism in CKD patients, its relevance to muscle spasms is indirect 1.
• Therefore, the recommendation to use baclofen for muscle spasms in CKD patients is based on the available evidence from a related field, with careful consideration of potential side effects and interactions.

From the Research

Muscle Spasms in Patients with CKD

• Muscle spasms are a common symptom in patients with chronic kidney disease (CKD) 2
• A study found that 38% of patients with CKD stage 4-5 pre-dialysis complained of chronic musculoskeletal pain, which includes muscle spasms 2
• The study also found that muscle cramps were one of the most common symptoms associated with chronic musculoskeletal pain in patients with CKD 2
• The pathogenesis of muscle spasms in CKD patients is not fully understood, but increased inflammatory markers may play a relevant role 2
• Phosphate binders such as lanthanum carbonate and sevelamer carbonate are commonly used to treat hyperphosphatemia in CKD patients, but their effect on muscle spasms is not well studied 3, 4, 5, 6

Treatment of Hyperphosphatemia in CKD

• Lanthanum carbonate and sevelamer carbonate are effective phosphate binders that can help reduce serum phosphate levels in CKD patients 3, 4, 5, 6
• A study found that lanthanum carbonate was more efficacious in lowering serum phosphate concentrations than sevelamer carbonate 3
• Another study found that lanthanum carbonate had a lower risk of hypercalcemia and improved nutritional status compared to other phosphate binders 4
• However, the effect of these phosphate binders on muscle spasms in CKD patients is not well studied and requires further research 3, 4, 5, 6

Clinical Characteristics of Muscle Spasms in CKD

• Muscle spasms are more prevalent in women than in men with CKD 2
• Elderly age, obesity, and comorbidities such as diabetes, heart failure, and COPD are associated with an increased risk of muscle spasms in CKD patients 2
• Increased inflammatory markers such as C-reactive protein and non-neutrophilic leukocytes are also associated with muscle spasms in CKD patients 2
• However, the clinical characteristics of muscle spasms in CKD patients require further study to fully understand their pathogenesis and treatment 2