Muscle Cramp Rate, Severity and Burden in Maintenance Hemodialysis Patients
Eduardo Lacson, Nien Chen Li, Monica Shieu, Antonia Harford, Harold Manley, Caroline Hsu, Daniel E. Weiner, Dana Miskulin, Seda Babroudi, Doug JohnsonBackground:
Cramps are common in dialysis patients 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 hemodialysis patients.
Methods:
A recurring three-question cramps questionnaire with a one-week recall period was embedded in routine care for maintenance hemodialysis patients over five diverse, geographically distributed outpatient clinics to determine occurrence rate, pain severity, and burden from muscle cramps. This was repeated every four weeks during 2024. Prevalent patients completing ≥3 questionnaires were categorized as never-crampers, occasional (<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 9 (IQR:7,11) questionnaires. Among this cohort, 159 (38%) never reported cramps, 208 (49%) reported occasional cramps and 53 (13%) reported frequent cramps. While 62% reported cramps at least once, on average, 19% reported cramps every four-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 1-point increase in maximal pain score associated with a 0.74 increase in bother score (P<0.001).
Conclusions:
Surveys done every four weeks showed that one in five hemodialysis patients report muscle cramps with significant burden, albeit only one in eight cramp frequently. While 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.