How to Prevent Dialysis Muscle Cramps

If you’re among the nearly 500,000 people on dialysis in the US, you may have experienced the discomfort of muscle cramping. Cramps are usually painful and may make you feel discouraged about your treatments. However, there are steps you can take to potentially prevent and relieve dialysis muscle cramps and related symptoms.

The following may be signs you have an oncoming muscle cramp:¹

1. Muscles twitches
2. Firm or tender muscles.
3. Pain in an area that cramps

If you notice these signs or begin to have muscle cramps during dialysis, let a member of your care team know right away. Common causes of cramping, such as low blood pressure and rapid fluid removal, can be addressed by:

• Placing you flat on your back with your legs slightly elevated¹
• Gently stretching the muscle¹
• Reducing the rate of fluid removal
• Administering normal saline

The most frequent causes of dialysis muscle cramps include rapid or excessive fluid removal, intradialytic hypotension (low blood pressure during dialysis), and electrolyte disturbances. Factors associated with dialysis cramps include:

• Excessive weight gain between dialysis treatments: This excess fluid must be taken off at your next dialysis session, and you’ll need a higher ultrafiltration (UF) rate to achieve your dry weight (normal weight with no additional fluid). If your body can’t handle the higher UF rate, you may cramp.
• Overly aggressive fluid removal: Cramps can also happen if too much fluid is removed during the treatment. Tell a member of your care team if you think you may have gained weight.
• Cutting dialysis sessions short or skipping treatments: Reduced time on dialysis can lead to excessive fluid gains, requiring higher UF rates, which can cause cramping.
• Too much salt (sodium): High-sodium foods in your diet can cause increased thirst and excessive fluid gains between treatments, requiring a higher UF rate.

These steps may reduce or prevent dialysis muscle cramps:

1. Longer or more frequent treatments—If prescribed by your doctor, extending dialysis time or receiving therapy more frequently each week can lower your UF rate, helping decrease the risk of cramping.
2. Complete your dialysis sessions as prescribed—Completing your full dialysis sessions as prescribed can help manage your fluid and prevent fluid overload.²
3. Manage fluid gains between treatments—Follow your plan for daily intake of liquids to prevent fluid overload, also called hypervolemia.³
4. Manage sodium intake—Limit sodium (salt) intake to 2,000 mg or less. Too much sodium can make it harder for your kidneys to balance the sodium and water in your body. That can mean feeling thirsty, which can lead to fluid weight gain.⁴
5. Consider home dialysis—Peritoneal dialysis (PD) and home hemodialysis (HHD) are home dialysis modalities that can be prescribed by your nephrologist. Because they are administered more frequently than in-center hemodialysis, PD and HHD can help your body regulate fluid better, and may reduce the potential for cramping.^5,6

Muscle cramps during dialysis are painful. They can make people feel apprehensive about their treatments and are sometimes severe enough that therapy must be cut short. But changes to your diet, fluid intake, dialysis prescription, and other factors may help prevent or relieve the discomfort associated with cramping.

If you are having muscle cramps during dialysis, talk to a member of your dialysis care team. They know you and your dialysis routine and can help you find the best ways to overcome cramping.

References

¹ Agar, Dr. John. Home Dialysis Central. 2014. “Heading Off the Dreaded Cramp!” https://homedialysis.org/news-and-research/blog/32-heading-off-the-dreaded-cramp.

² Fresenius Kidney Care.“The Importance of Removing Excess Fluid.” Accessed September 9, 2021. https://www.freseniuskidneycare.com/thrive-central/removing-excess-fluid.

³Fresenius Kidney Care.;Hypervolemia and Signs of Fluid Overload. Available at: https://www.freseniuskidneycare.com/thrive-central/hypervolemia. Accessed 9 September 2021.

⁴ Fresenius Kidney Care. “Choosing Low Sodium Foods.” Accessed September 9, 2021. https://www.freseniuskidneycare.com/thrive-central/low-sodium-foods.

⁵ Fresenius Kidney Care. “Home Hemodialysis: What to Expect.” Accessed September 9, 2021. https://www.freseniuskidneycare.com/treatment/home-hemodialysis/what-to-expect.

⁶ Fresenius Kidney Care. “Benefits of Home Dialysis.” Accessed September 9, 2021. https://www.freseniuskidneycare.com/treatment/benefits-of-home-dialysis.