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Muscle cramps in dialysis patients

Jean L Holley, MD, FACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


Muscle cramps are a common complication of hemodialysis treatments, occurring in 33 to 86 percent of patients [1-3]; they often result in the early termination of a hemodialysis session and are therefore a significant cause of under-dialysis. The exact etiology of cramps in dialysis patients is unknown. Since cramps tend to occur most frequently near the end of hemodialysis treatments, changes in plasma osmolality and/or extracellular fluid volume have been implicated.

The pathophysiology, clinical features, and treatment of cramps occurring in association with dialysis will be reviewed here. A general overview of muscle cramps and other acute complications of dialysis are presented separately. (See "Nocturnal leg cramps" and "Acute complications during hemodialysis".)


A cramp is a prolonged involuntary muscle contraction that occurs in a muscle that voluntarily contracts when it is already in its most shortened position [4]. The increased frequency of cramps at rest and during the night may be caused by the placement (by the plantar-flexed foot) of the calf and ventral foot muscles in the most shortened and vulnerable position during sleep [4].

Electromyography reveals that cramps begin with fasciculations in various muscle parts that subsequently progress to high-frequency action potentials. The origin of a cramp is therefore neural, not muscular [4].

The etiology of hemodialysis-associated cramps may include contributions from one or more of the following factors [1,4,5]:

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Literature review current through: Nov 2017. | This topic last updated: Sep 18, 2017.
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