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Muscle Cramp Rate, Severity, and Burden in Maintenance Hemodialysis Patients: A Yearlong Multicenter Quality
Eduardo Lacson1,2, Nien Chen Li1, Monica Shieu1
1Dialysis Clinic, Inc., Nashville, Tennessee.
Insights
Muscle cramps affect nearly one in five hemodialysis patients, causing significant pain and bother. Frequent crampers are targets for intervention, but occasional crampers also need attention.
Area of Science:
- Nephrology
- Quality Improvement
- Patient-Reported Outcomes
Background:
- Muscle cramps are a prevalent yet understudied issue in hemodialysis patients.
- Limited data exists on the long-term prevalence and patient burden associated with these cramps.
- This study aimed to establish a baseline understanding of cramp occurrence and impact.
Purpose of the Study:
- To evaluate the prevalence and natural history of muscle cramps in maintenance hemodialysis patients.
- To quantify the pain severity and patient-reported burden of muscle cramps.
- To inform clinical practice and identify patient subgroups for targeted interventions.
Main Methods:
- A prospective quality improvement initiative using a recurring questionnaire administered every four weeks.
- Data collected from 420 patients across five outpatient hemodialysis clinics over 2024.
- Patients categorized into never, occasional, and frequent crampers based on response frequency; pain and bother scores analyzed.
Main Results:
- 38% never cramped, 49% occasionally, and 13% frequently.
- On average, 19% reported cramps every four weeks, with 69% experiencing moderate to severe pain.
- Pain and bother scores were highly correlated (0.72), with increased pain significantly worsening bother.
Conclusions:
- Approximately 20% of hemodialysis patients experience muscle cramps with substantial burden.
- Frequent crampers are potential candidates for clinical trials.
- Interventions are needed for both frequent and occasional crampers due to high patient bother.
Key Points:
Identifying patients who cramp frequently over time is crucial for designing intervention studies to prevent cramping. One in five patients receiving hemodialysis reported muscle cramps every 4 weeks posing significant burden, although only one in eight patients cramped frequently In addition, population-based interventions are needed to address the high proportion of patients who are bothered by occasional cramps.
Background:
Cramps are common in patients on dialysis, yet data on prevalence over time and patient burden are lacking. This quality improvement initiative evaluated the prevalence and natural history of muscle cramps to provide clinicians with baseline understanding of the magnitude and scope of cramping in patients on hemodialysis.
Methods:
A recurring three-question cramps questionnaire with a 1-week recall period was embedded in routine care for patients on maintenance hemodialysis over five diverse, geographically distributed outpatient clinics to determine occurrence rate, pain severity, and burden from muscle cramps. This was repeated every 4 weeks during 2024. Prevalent patients completing ≥3 questionnaires were categorized as never-crampers, occasional crampers (<50% of responses with cramps), and frequent crampers (≥50% with cramps). The association between concurrent pain severity and bother scores (each ranging from 0 to 10) and changes in these scores were compared using linear regression.
Results:
There were 420 patients who completed a median of nine (interquartile range, 7-11) questionnaires. Among this cohort, 159 (38%) never reported cramps, 208 (49%) reported occasional cramps, and 53 (13%) reported frequent cramps. Although 62% reported cramps at least once, on average, 19% reported cramps every 4-week period (range 11%-25%). Most patients (69%) reported at least one cramp episode as moderate to severely painful while 60% reported cramping as moderate to extremely bothersome. Pain and bother scores for the same week correlated (0.72, P < 0.001). Between consecutive questionnaires, each one-point increase in maximal pain score associated with a 0.74 increase in bother score ( P < 0.001).
Conclusions:
Surveys done every 4 weeks showed that one in five patients on hemodialysis report muscle cramps with significant burden, although only one in eight cramp frequently. Although patients who cramp frequently may be appropriate targets for initial intervention trials to prevent cramps, additional interventions could address the high proportion of patients who are bothered by occasional cramps.
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