By Paul Kellerman, MD
As many of you have experienced, muscle cramps are a common complication during dialysis treatments. Cramps occur in 1/3 to 2/3 of all dialysis patients. Patients tend to experience cramps in the lower extremities, but they can occur in the hands, arms and abdominal muscles as well.
Although the exact cause is unknown, multiple causes have been proposed, including volume contraction (getting "too dry"), low blood sodium concentration, low body magnesium, and carnitine deficiency. Of these, the first two seem to be the most common. In terms of volume contraction, both getting below your "dry weight" (goal weight at the end of dialysis), as well as rapid removal of large volumes can result in cramps. Low concentrations of sodium in the dialysis bath can also cause cramps by lowering your blood sodium concentration.
Treatment has two components: prevention of cramps from occurring, as well as treatment of cramps when they occur. In terms of prevention, some of these measures are under your control, and some under your care team's control.
What works to prevent cramps?
What can be done when you get cramps on dialysis?
So in summary, if you have frequent cramps while on dialysis, what do you do? If you gain a lot of fluid, you need to decrease your fluid intake. If you don't have large fluid gains, talk with your doctor about reassessing your dry weight. If adjusting your dry weight does not solve the problem, you may be a candidate for dialysate sodium modeling, carnitine, quinine or Vitamin E.
Above all, we certainly don't want dialysis to "cramp" your lifestyle.
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