A regular viewer emailed KidneyBuzz.com and asked, "My husband is in constant pain after dialysis. One of the things that always is bothering him is very painful cramps throughout his body. Is there anything that he can do about this?"
Muscle cramps (involuntary muscle contraction associated with severe pain) occur frequently in patients receiving Dialysis. Muscle cramps can involve the legs, most commonly in the feet, but can also involve arms and hands, as well as abdominal muscles. It is estimated that 33% to 86% of Chronic Kidney Disease patients conducting Dialysis have experienced cramps. Use the following tips to combat and correct muscle cramping as a result of Dialysis.
Signs of oncoming severe muscle cramps include muscle twitches, local pain at the site of the cramp which can be severe, and firmness or tenderness of the involved muscle. As most Chronic Kidney Disease and Dialysis patients know, cramps can be so painful a patient can hardly move. Unfortunately, this can occur during Dialysis Treatments and it is not unusual for the cramp to lead to the Dialysis Session being terminated earlier than planned - possibly leading to a less effective treatment, sickness, and additional health complications.
There are numerous factors that directly contribute to muscle cramps in Chronic Kidney Disease patients receiving Dialysis including a decrease in body fluid volume, abnormally low blood pressure (Hypotension), changes in electrolyte-water balance, low levels of sodium, inadequate oxygen, low magnesium in blood, carnitine (an amino acid) deficiency, and elevated serum leptin (a hormone that regulates appetite and energy).
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Non-medicinal strategies can be employed in order to prevent cramps such as decreasing the amount of fluid you take off during treatment. In order to better balance fluid withdrawl patients can simply regularly evaluate their appropriate dry weight including trying to minimize weight gains between Dialysis Treatments. However, if your weight fluctuates regularly, then consider asking your Nephrologist for a "Sliding Goal" in which you can increase or decrease your fluid withdrawal goal slightly based on weight loss or weight gains between treatments. You know your body better than anyone else, and it is your right to be able to leave Dialysis Treatments without severe pain.
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If you are experiencing cramps during Dialysis Sessions, it is important to assess your Blood Pressure Levels. Dialysis-related Low Blood Pressure may be treated through slowing or stopping ultrafiltration, lying in the Trendelenburg (flat on back) position, or reducing your blood flow rate.
Loved ones and Caregivers should note that local massage of the affected muscle and the application of moist heat may provide some comfort to Chronic Kidney Disease patients conducting Dialysis. Other low-risk strategies include performing stretching exercises before Dialysis, performing a mild exercise such as riding a stationary bicycle during Dialysis or prior to bedtime, minimizing alcohol and caffeine, and keeping bed covers loose and not tucked in to prevent cramps. Local heat (including showers or baths) or ice, walking or leg jiggling followed by leg elevation, are other methods reported to help relieve muscle cramps.
If non-medicinal treatments do not relieve your cramps then you should discuss with your Nephrologist medicinal options. Specifically, Quinine is a medication that has been used for many years for the treatment of cramps both in the general population and in the Chronic Kidney Disease Community. Quinine was approved only for the treatment of malaria and is used off-label to treat cramps. Quinine reduces leg cramps by decreasing excitability of the nerve stimulations, which increases the muscle refractory period and, subsequently prevents prolonged muscle contractions. Quinine does not require a dose reduction for reduced renal function but has a delayed onset of action, so it must be administered one to two hours prior to starting hemodialysis, according to reports.
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Still, you and your Healthcare Team can determine what is best for you. This is especially important since there is some debate as to the risk-benefit ratio of the above treatment because Quinine has considerable, potentially dangerous, side effects. Studies suggest that vitamin E may be an alternative therapy for the management of leg cramps for Chronic Kidney Disease patients receiving Dialysis. Results showed that there was a 68.3% reduction in the number of attacks across the board, with no trends relating to age or gender, nor Hemodialysis duration. It has been found that short-term treatment with vitamin E is a safe and effective treatment for patients suffering from cramps during and after Dialysis. KidneyBuzz.com advises that you check with your doctor to ensure that there are no long-term adverse effects from the vitamin E regimen. In fact, interactions with Vitamin E and Anticoagulants (i.e Warfarin or Heparin), cause concern for bleeding risk which may limit use in some Dialysis patients.
How do you manage your cramping? What are some tips and tricks that you have found useful? Share your insights and learn from others with Chronic Kidney Disease, Dialysis, Diabetes and High Blood Pressure by Liking KidneyBuzz.com and joining the discussion with over 72,000 Friends (click here). Similarly, visit KidneyBuzz.com every day so you, along with the other 250,000 monthly visitors, can access the Number One (#1) source of Daily News, Information, Impact Meals, Inspiration, and tailored Products and Services to help teach those with Chronic Kidney Disease, Dialysis, Diabetes and High Blood Pressure how to better manage and improve their lives. You may be a regular visitor like Sheron E Sidbury who wrote, "No questions yet. Dealing with CKD in my family. Your site is awesome with so much helpful information I know I will be spending alot of time here." You are always welcome to contact us directly at firstname.lastname@example.org for any questions, updates or concerns.