Cramping on Dialysis is a common issue for patients.
The usual causes are:
High fluid gains in between sessions
Shortened time on Dialysis
High salt intake leading to high fluid intake
Low Blood Pressure
Missing treatments1,2
In regards to above it is imperative one follows the fluid restriction guidelines which tends to be about 1 liter a day for dialysis patients. Sodium should be avoided, remembering most of the salt is in the pre-packaged food, not what you add with the salt shaker. Staying for the entire treatment and not missing treatments ensures the ability to remove fluid over a sufficiently safe amount of time and avoids large fluid shifts. Lastly regarding low blood pressure (this is something to speak to your provider about) many patients may want to hold their anti-hypertensive medications pre dialysis or avoid ones that are not dialyzed off, especially if the pressure runs low while on the machine.
While these are all important causes for cramping, and should be addressed to the best of your ability (patients and providers), there are also other less known but nonetheless equally important, contributing factors.
Other contributing factors to cramps are vitamin and electrolyte deficiency, muscle fatigue, neurologic dysfunction, and impaired oxygen delivery to the muscles.3
In regards to muscles specifically, Carnitine deficiency may play a large role. Carnitine is produced in the Liver and Kidneys, is removed up to 70% in a single dialysis session, and mostly comes from Dairy and Meat consumption, both of which tend to be low or restricted in dialysis patients. Carnitine deficiency, therefore, is ubiquitous amongst dialysis patients.4
Carnitine deficiency symptoms include:
Muscle weakness
Cardiomyopathy
Cramping
Low energy
Anemia.4, 5, 6, 7
There are numerous studies supporting the view that L-carnitine supplementation improves:
lipid profile, exercise capacity and oxygen utilization, muscle strength
intradialytic symptoms, sense of well-being, hospitalization rate, inflammatory markers, protein metabolism, left ventricular hypertrophy and cardiac function, anemia, and response to erythropoietin.4
L-Carnitine even at modest oral doses, 600 mg/day, has been shown to improve muscle spasms and hemoglobin concentrations in Dialysis patients over a 12 month time span.9
In fact L-Carnitine supplementation is approved by CMS for those that are deficient and have refractory symptoms like low blood pressure and treatment resistant anemia on dialysis.6
L-Carnitine supplementation is also suggested to be of benefit by the KDOQI Guidelines “in certain patients who are unresponsive to conventional methods for symptoms of muscle weakness, low energy, and cramping.”10
What about Vitamins? More on this in upcoming posts, but yes! In one recent well executed trial Vitamin E and C in combination were shown to be of benefit for cramping on dialysis. 40 dialysis patients were randomized in a double blinded placebo controlled fashion to receive either Vitamin E, Vitamin C, C & E or placebo. The combination of Vitamins C + E reduced cramping frequency by a whopping 97% vs only 7% in the placebo group.8
Given all of the above is their a multivitamin/supplement that has the correct amounts, and types of vitamins and nutrients for dialysis patients? We are happy to say yes there is. DialysisAide by KidneyAide is the only dialysis vitamin that contains all of the water soluble B vitamins essential to dialysis patients alongside Vitamins C, E, and L-Carnitine. DialysisAide also contains Zinc-Oxide for added immune support. You can read more about DialysisAide and various guidelines, recommendations as well as real patient testimonials here. For well under 1 dollar a day you can do Dialysis better with DialysisAide.
References:
- https://www.kidney.org/news/coping-with-symptoms-while-on-dialysis. Accessed April 19, 2022
- https://www.freseniuskidneycare.com/thrive-central/how-to-prevent-dialysis-related-muscle-cramps, Accessed April 19, 2022
- https://www.renalfellow.org/2021/09/27/pickle-juice-for-dialysis-related-muscle-cramps-fact-or-myth/ AccessesApril 18,2022
- https://www.uptodate.com/contents/carnitine-metabolism-and-deficiency-in-kidney-disease-and-dialysis?search=muscle-cramps-in-dialysis-patients, Accessed April 19, 2022
- KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure Appendix X
- CMS.Gov Levocarnitine for End Stage Renal Disease
- European Best Practice Guidelines on Nutrition in Dialysis. Nephrol Dial Transplant (2007) 22 [Suppl 2]: ii45–ii87 doi:10.1093/ndt/gfm020
8, Khajehdehi P, Mojerlou M, Behzadi S, Rais-Jalali GA. A randomized, double-blind, placebo-controlled trial of supplementary vitamins E, C and their combination for treatment of haemodialysis cramps. Nephrol Dial Transplant. 2001 Jul;16(7):1448-51. doi: 10.1093/ndt/16.7.1448. PMID: 11427639.
9. Kuwasawa-Iwasaki M, Io H, Muto M, Ichikawa S, Wakabayashi K, Kanda R, Nakata J, Nohara N, Tomino Y, Suzuki Y. Effects of L-Carnitine Supplementation in Patients Receiving Hemodialysis or Peritoneal Dialysis. Nutrients. 2020 Nov 1;12(11):3371. doi: 10.3390/nu12113371. PMID: 33139659; PMCID: PMC7692097.
10. KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure Appendix X