Dialysis and Cramping updated

crampsCramping isn’t good!  CRAMPING IS BAD!

(update 6/26/16: See the comments for more thoughts about cramping)

Aside from the fact that it is excruciatingly painful, it is an indication that something is wrong during dialysis.  Too much fluid is being removed or fluid is being removed too quickly.  I’ve had my leg cramp so hard I thought it was going to break a bone and brought me to tears.

You get cramps when the muscles don’t have enough fluid for their proper operation.  Some people get cramps in major muscles like their legs or in muscles furthest away from their heart, like feet.  I even had cramps in my hands that caused me too look like I’m awkwardly signing “Live long and Prosper” to Captain Kirk.  All kidding aside, it is very painful and feels like torture.  I’ve seen many patients brought to screaming from the pain.  And, it is an indication something is amiss in dialysis.

If you are cramping often, talk with the technician about the rate of flow and the amount of fluid being removed.  If they don’t seem to have an understanding of the problem and offer some relief, talk with the nurse.  Then, if you aren’t getting a reasonable response, speak with the doctor.  Perhaps your “dry weight”  (your weight after dialysis) needs to be increased because you’re taking off too much fluid or you’re taking it off too quickly.  Perhaps you need to explore adding an additional session that week so you don’t have to remove too much fluid in just three sessions and a fourth will help.  My center will sometimes have a chair available on Saturday and I come in for a fourth session.  I have had to do it during the holidays when eating and drinking too much is often my failing.  Ask and discuss it with the nurse.  Some centers don’t have that opportunity though because they are at capacity.  But at least explore the option.  However, with some work on your part it shouldn’t be necessary.

Make sure you are part of the fluid removal calculation.  When you come into dialysis, you weigh in.  The amount of fluid to be removed is your weight before dialysis minus your dry weight.  Too often the tech just does a quick calculation and doesn’t review it with you but enters that information into the machine and off you go. Some patients don’t know how much is being taken off.  Don’t let that happen. Engage.  Ask the tech how much is being taken off.   Check their math, so to speak.  Be observant and discover your limit.  My tech, Bobby, pointed out that I can only tolerate a maximum fluid removal of 5.5 liters. If I exceed 5.5, I’ll start cramping.  For example, if I am six liters over my dry weight,  he told me to just do 5.5 or less and be careful with my fluid before the next treatment and take off the rest in the next treatment. Don’t exceed 5.5 liters in the four hour treatment.  Great advice.  (See my blog about Fluid Control . You have to limit your fluid intake between sessions for your own good!

If the cramping comes before the last hour and your dry weight is correct, it may be the rate of flow. Too much fluid is being removed from the blood too quickly.  Again, speak with the tech, nurse, or doctor about reducing the flow rate or, another option, extending the treatment time. As much as I dislike sitting in that chair for any longer than necessary, adding another fifteen to thirty minutes could mean less fluid has to be removed as quickly and you benefit by avoiding cramping.

If cramping occurs, one method of immediate relief is to add saline to your blood increasing the volume of fluid in your blood.  This really isn’t doing you much good.  You should be removing fluid, not adding it. Also, saline adds salt (sodium) and makes you thirsty for more fluid!  It’s counter-productive.  Another method is to have the tech stop the fluid removal for a few minutes (perhaps 10 of 15 minutes).   Your blood continues to be cleaned but no fluid is being removed.  This is a better option.   Engage the tech when you start feeling cramps coming on.  Learn to sense when they are beginning and take immediate action to avoid them.

Again, cramping is not good.  It’s an indication something is wrong.  Some centers and technicians don’t understand this.  They act as if it’s just part of the treatment “experience”.  No it isn’t!  It should never (or rarely) be happening.  I went through a couple years of frequent cramping at such a center.   Where I am now, they don’t allow cramping and do whatever they can to make it nonexistent.  The dialysis goes better and I don’t have to endure any pain.  I do my best to manage my fluid and they do their best to help me avoid cramping.

(In another posting, I will discuss Blood Pressure and Dialysis.  As fluid is removed or is removed too quickly, your blood pressure will drop.  This is more likely than cramping for me!  But that’s for another blog.)

If you have some experience and can offer some advice, please feel free to comment.

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About DevonTexas

I am a person with ESRD (End Stage Renal Disease) which means my kidneys don't work. Forty or so years ago that would have been a death sentence but today there is Dialysis which means I can be hooked up to a machine that will clean my blood as the kidneys should. Three days a week, I go to a center and have too very large needles stuck in my arm to remove and replace my blood as it passes through a process where it's cleaned and the fluid is removed, a process taking a little over four hours each time. I want to advance knowledge about dialysis so that other patients can learn from my experience and mistakes. We shouldn't have to reinvent the wheel, eh? There is so much to be learned and experienced about our predicament. There are vast resources available to support us and enrich our lives but many patients don't know about them. There are also many issues that we have to deal with whether we want to or not. So I blog about them. All comments are confidential until I approve them. If you don't want your comment public, let me know and I will respect that. So, feel free to leave a comment. Enjoy.
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9 Responses to Dialysis and Cramping updated

  1. cattlekid says:

    I’ve only had the excruciating cramps once when I was in-center. They immediately shut off the UF and the nurse applied pressure to my foot, basically a reverse stretch of the leg that was cramping and that seemed to help the situation. The other thing that I have noticed is that I have to shift position frequently when I am on treatment, if not, I get a minor cramp here or there which can be resolved by applying the same reverse stretch that the nurse did for me.

    I would always double-check the tech’s fluid removal calculations as well as check the machine. There were times when they would set the machine wrong or do the math wrong. It got to the point where I would refuse any fluid removal over 2.5 liters. Now that I do treatments at home and my appetite has improved dramatically, I’ve had to up my dry weight almost 2 kilos and still keep to the 2 liter limit – there’s always tomorrow.

  2. devontexas says:

    Thank you for your comment. It will be helpful to others who have the same problem.

  3. Sue Bodansky says:

    This was so helpful to read. My mother just started dialysis – she’s had two treatments in the hospital and tomorrow will be the third. She has complained so much about the pain and cramping that she’s already ready to give up and now can’t sleep because she’s so scared about tomorrow. The first session they removed 3 1/2 liters of fluid and were going for 2 1/2 the second time. I plan to relay all your information to her. Hopefully it will help! Thanks!

  4. Cathy says:

    My Mom has bad charlie horses in her legs and hands. the doctor and the center said that they don’t remove a lot of fluid off of her and that they don’t have the steps where it pulls harder at the end. I just don’t know what to do for her. I
    hate to see her suffer like that.

    • DevonTexas says:

      The question is not if they remove a lot of fluid but if they remove too much. Also when are the cramps occurring? During dialysis, long after dialysis? They should try removing less and see how that goes. Another question is “what other things may be causing her cramps”? Side effect of Medications? A friend of mine suggests sucking on a broken off bit of concentrated chicken broth cubes. They are very high in sodium/salt and that helps her avoid severe cramps. I don’t necessarily recommend that but it may work for your mom.

  5. Lyn says:

    My husband 63 yrs old, he has ongoing dialysis as of now, everytime he sit in that chair he always felt the cramping as if like he’s going to die. I’m so thankful to read this article and now we have an idea what to do next time. Thank you so much sir.

    • DevonTexas says:

      Lyn, thanks for the thanks. (Please excuse the delay responding to you). As you may know now, cramping is BAD. The techs and docs should NOT allow it. But, unfortunately, it’s the patient that must enforce the rule.

  6. gabe says:

    hi! lyn just want to ask besides from too much fluid taken from the patient.. do you think increase blood flow rate also contribute to muscle cramping.. thanks

    • DevonTexas says:

      Excellent question. I will research that.

      But I suspect that flow may not directly contribute as it doesn’t relate to fluid removal more than it is the amount of blood being processed. Flow rate is the rate at which the machine recirculates the blood. The fluid removal is the factor that matter most in cramping.

      Taking off too mush or too fast can cause cramping. In some patients (like me), it takes a while to find to right combination of fluid removal over time. For example, if you come in with 2 kilos over your dry weight and run for four hours that is about half a kilo per hour of fluid removal. If you come in at four kilos over, that’s one kilo per hour. Keep this is mind as you determine the amount to take off.

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