Severe muscle cramps lasting all day

Hi I’ve been on PD for 16 months and in the beginning everything went pretty smooth. Then about 8 months ago, I started getting leg cramps whenever I used the green bags on my cycler. I went to only using yellow bags, which helped alot! Now it seems I’m getting leg cramps that can last all day and muscle cramps in other parts of my body (ribs, thighs, stomach) often without warning. I’m still exhibiting minor edema in my legs. I’ve discussed this with my Dr and PD nurse and they tell me they’ve never heard of any others like this. Any ideas or help would be much appreciated! thank you

Hi Stacey!

I am so sorry to hear that you are having leg cramps–no one wants those. I’ve asked a PD nurse to pop in and answer, and I hope he will. Meanwhile, typically cramps are caused by an electrolyte imbalance. Electrolytes are salts in your blood that carry electrical signals from your muscles to your nerves and back. They include:

  • Sodium

  • Potassium

  • Magnesium

  • Calcium

  • Phosphorus

  • Chloride

Basically, as you pull water out of your blood, you may be washing out too much of these electrolytes, too. Some are easy to test in your blood. Magnesium is not, and it is a frequent flyer as far as causing cramps, along with sodium and calcium. You can have a blood test for magnesium, but 99% of body magnesium is not in your blood—it is inside and between your cells.

You might:

  • Ask your doctor if it is okay for you to take a bath with **Epsom salts (**magnesium) or to use a magnesium lotion to see if it helps. Magnesium can be absorbed through your skin.

  • You could look at your blood test levels for calcium and sodium to see if they are trending down (or if these have not been tested recently, ask for them to be tested).

These may be a start, at least.

I have had several patients transfer to my facility that were on green bags (2,5%) daily. They were Removing 1800 a night with a fluid restriction of 32oz. These sort of prescriptions will dehydrate you and shut down your kidneys. It equivalent to dehydrating you in the hemodialysis setting with Tom high of goals for fluid removal. The reason you weren’t cramping on 1.5% to begin* was that you were not getting too dry in the beginning. Then eventually you still were getting to dry even with the 1.5%

All our patients are encouraged to drink 2L a day to maintain fluid status and prevent cramps. Discuss with your nurse or doctor increasing your fluid intake, especially if you are on lasix. You have to put out what you put in. If you UF 1000 and urinate 1000 you need 2L to prevent getting cramps.

Thank you, Josh! Stacey, Josh is the PD nurse I asked to reply to you. He knows his stuff!

I have been on PD since Oct 2020 and was on Hemo for 4-5 months prior to that. I receive one 2.5 and one 1.5 every night for 5 cycles for a total of 10 hrs, and receive a total of 11.500 ml a night. I have had a problem with my legs getting tired, but not cramping, ever since I got out of the hospital after a 30 day stay. All my labs are always good. My UF usually is between 700 and 1200 a therapy plus I always take a manual drain at end of therapy.

Assuming all of your labs are OK, if you were in the hospital for 30 days recently, it’s very likely that you lost muscle mass in your legs. In just a few days of bedrest, you can lose a significant amount of muscle mass. Expect it to take time and some increasing physical activity to build back strength in your legs and probably your upper body as well. You might want to read this blog that has links to resources for increasing exercise. You might also want to ask your doctor if s/he would refer you for physical therapy. Exercise in Kidney Disease: Is the U.S. Slow in Acknowledging Its Value? - Home Dialysis Central