Factors Related to Muscle Cramps During Hemodialysis in End-Stage Renal Disease Patients
DOI:
https://doi.org/10.33165/rmj.2021.44.4.249293Keywords:
Muscle cramps, End-stage renal disease, HemodialysisAbstract
Background: Muscle cramps are a common complication during hemodialysis that can cause patients extremely painful.
Objective: To determine factors related to muscle cramps during hemodialysis in patients with end-stage renal disease.
Methods: A descriptive correlational study was conducted in end-stage renal disease patients undergoing hemodialysis at Hemodialysis Center, Faculty of Medicine Ramathibodi Hospital between February and March 2020. Data collection instruments included muscle cramps report form, demographic questionnaire, and factors related to muscle cramps questionnaire. Data were analyzed using descriptive statistics and multiple logistic regression.
Results: A total of 44 patients were recruited in the study. The mean age was 63.3 years. A total of 458 muscle cramps during hemodialysis assessments were recorded in the one month. The result showed that 45 muscle cramps (9.8%) occurred during hemodialysis. Factors significantly related to muscle cramps during hemodialysis included interdialytic weight gain (≥ 3.5 kilograms) (OR, 4.5; P < .001), experiencing cramps before hemodialysis (OR, 25.5; P < .001), and high serum bicarbonate concentration (OR, 5.6; P = .005).
Conclusions: This study found that 9.8% of patients reported muscle cramps during hemodialysis. Interdialytic weight gain, having cramps before hemodialysis, and serum bicarbonate concentration were significantly related to muscle cramps during hemodialysis in patients with end-stage renal disease.
References
Apikulwanit N, Potaporn M. 8 Millions of Thai people has suffered with chronic kidney diseases. Health Station. April 2, 2018. Accessed February 10, 2021. https://www.healthstation.in.th/action/viewarticle/1434/?fbclid=IwAR0yAiqLCVNfmI9_DxnmJFCSGKoA5wYT0GgsXOnnA7pHdClsDeX2lIteH0
Kochasenee P, Jittianun A. Chronic Kidney Disease and Initiation of Dialysis. In: Nongnuch A, Teeratanakul K, Srisuwan K, Oprtchareonsuk W, eds. Essentials in Hemodialysis. 2nd ed. Text and Journal Publication; 2019:1-20.
National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884-930. doi:10.1053/j.ajkd.2015.07.015
Lee WC, Lee YT, Li LC, et al. The number of comorbidities predicts renal outcomes in patients with stage 3-5 chronic kidney disease. J Clin Med. 2018;7(12):493. doi:10.3390/jcm7120493
Sangsonwong S. Nursing Issues in Acute Hemodialysis Complications. In: Nongnuch A, Teeratanakul K, Srisuwan K, Oprtchareonsuk W, eds. Essentials in Hemodialysis. 2nd ed. Text and Journal Publication; 2019:261-280.
Moledina DG, Perry Wilson F. Pharmacologic treatment of common symptoms in dialysis patients: anarrative review. Semin Dial. 2015;28(4):377-383. doi:10.1111/s di.12378
Almutary H, Bonner A, Douglas C. Symptom burden in chronic kidney disease: a review of recent literature. J Ren Care. 2013;39(3):140-150. doi:10.1111/j.1755-6686.2013.12022.x
Kobrin SM, Berns JS. Quinine--a tonic too bitter for hemodialysis-associated muscle cramps? Semin Dial. 2007;20(5):396-401. doi:10.1111/j.1525139X.2007.00330.x
Stern LZ, Bernick C. Muscle Cramps. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; 1990. Accessed February 10, 2021. https://www.ncbi.nlm.nih.gov/books/NBK376/
Flythe JE, Dorough A, Narendra JH, Forfang D, Hartwell L, Abdel-Rahman E. Perspectives on symptom experiences and symptom reporting among individuals on hemodialysis. Nephrol Dial Transplant. 2018;33(10):1842-1852. doi:10.1093/ndt/gfy069
Holley JL, Bems JS, Sheridan AM. Muscle cramps in dialysis patients. Up To Date. Update February 10, 2019. Accessed February 10, 2021. https://www.uptodate.com/contents/muscle-cramps-in-dialysis-patients
Ipema KJ, Kuipers J, Westerhuis R, et al. Causes and consequences of interdialytic weight gain. Kidney Blood Press Res. 2016;41(5):710-720. doi:10.1159/000450560
Sarkar SR, Kotanko P, Levin NW. Fellows’ forum in dialysis: interdialytic weight gain: implications in hemodialysis patients. Semin Dial. 2006;19(5): 429-433. doi:10.1111/j.1525-139 X.2006.00199_1.x
Ulu MS, Ahsen A. Muscle cramps during hemodialysis: what can we do? new approachs for treatment and preventing. Eur J Gen Med. 2015;12(3):277-281. doi:10.15197/ejgm.01391
Punj S, Enaam A, Marquez A, Atkinson AJ Jr, Batlle D. A survey on dialysis-related muscle cramping and a hypothesis of angiotensin II on its pathophysiology. Kidney Int Rep. 2020;5(6):924-926. doi:10.1016/j.ekir.2020.03.003
Mastnardo D, Lewis JM, Hall K, et al. Intradialytic massage for leg cramps among hemodialysis patients: a pilot randomized controlled trial. Int J Ther Massage Bodywork. 2016;9(2):3-8. doi:10.3822/ijtmb.v9i2.305
Raymond CB, Wazny LD. Treatment of leg cramps in patients with chronic kidney disease receiving hemodialysis. CANNT J. 2011;21(3):19-23.
Daugirdas JT. Dialysis hypotension: a hemodynamic analysis. Kidney Int. 1991;39(2):233-246. doi:10.1038/ki.1991.28
Noh US, Yi JH, Han SW, Kim HJ. Varying dialysate bicarbonate concentrations in maintenance hemodialysis patients affect post-dialysis alkalosis but not pre-dialysis acidosis. Electrolyte Blood Press. 2007;5(2):95-101. doi:10.5049/EBP.2007.5.2.95
Kraut JA. Disturbances of acid-base balance and bone disease in end-stage renal disease. Semin Dial. 2000;13(4):261-266. doi:10.1046/j.15 25-139x.2000.00070.x
Sur M, Shah AD. Akalosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. Update January 12, 2021. Accessed February 10, 2021. https://www.ncbi.nlm.nih.gov/books/NBK545269/
Rocco MV, Burkart JM. Prevalence of missed treatments and early sign-offs in hemodialysis patients. J Am Soc Nephrol. 1993;4(5):1178-1183.
Bergeron MF. Muscle cramps during exercise-is it fatigue or electrolyte deficit? Curr Sports Med Rep. 2008;7(4):S50- S55. doi:10.1249/JSR.0b013e31817f476a
Lynch PG, Abate M, Suh H, Wadhwa NK. Magnesium and muscle cramps in end stage renal disease patients on chronic hemodialysis. Adv Nephrol. 2014;2014(5):1-6. doi:10.1155/2014/681969