Skeletal Muscle Cramp Prevalence among Patients Receiving Dialysis: A Global Systematic Review and Meta-Analysis

Skeletal muscle cramping among patients with end stage kidney disease receiving dialysis is not uncommon and has been identified by patients as a high priority, bothersome, unaddressed physical symptom. The primary objective of this systematic review was to quantify the global prevalence of skeletal muscle cramps among dialysis patients.

Four databases were searched through September 30th 2025. All available peer-reviewed observational and non-randomized experimental studies of non-hospitalized patients receiving dialysis reported in English were included in the analyses, whereas case reports/series, randomized control trials, systematic reviews, and meta-analyses were excluded. Timing of muscle cramps was dichotomized as overall or intradialytic. Random-effects meta-analysis was conducted to quantify the pooled prevalence of skeletal muscle cramps. Risk of bias was assessed using the Newcastle-Ottawa scale.

Ninety-four studies reported the prevalence of muscle cramps in 32,223 patients receiving dialysis across 36 countries on 5 continents. Most studies were performed in hemodialysis patients (n = 54, 57%), and 16 studies reported the prevalence of intra-dialytic cramps specifically. The overall pooled prevalence of skeletal muscle cramps was 55% (95% confidence interval (CI) 50%-59%, 95% prediction interval (PI) 20%-86%), whereas the pooled intradialytic prevalence of skeletal muscle cramps was 33% (95% CI 22%-47%, 95% PI 4%-87%). The prevalence of muscle cramps was higher among patients receiving hemodialysis vs peritoneal dialysis, new/incident vs prevalent patients, and a four-week vs one-week survey recall period, with significant between-study heterogeneity. Most studies (n= 50, 53%) were identified as having a moderate risk of bias.

The global overall pooled prevalence of muscle cramps among patients receiving dialysis was high (55%), though there were considerable between-study heterogeneity and risk of bias. Our findings highlight the complexity of quantifying skeletal muscle cramps among dialysis patients and offer insights into specific subpopulations and methods of symptom ascertainment for future epidemiologic, pathophysiologic, and therapeutic studies.