USA: Muscle cramps are common in stable end-stage renal disease (ESRD) patients on hemodialysis and often lead to poor treatment adherence. Researchers have found in a new study that dialysis with a higher dialysate magnesium concentration was associated with increased predialysis serum magnesium levels, reduced frequency and severity of muscle cramps, and improved compliance with hemodialysis. However, further studies are needed to confirm the efficacy and safety of this approach. The findings, published in Advances in Nephrology, are from a study led by Dr. Patrick G. Lynch from the Division of Nephrology, Department of Medicine, Stony Brook Medicine, New York, along with colleagues. The research team sought to better understand how dialysate magnesium concentration influences muscle cramping in patients with end-stage renal disease undergoing chronic hemodialysis.Muscle cramps are a frequent and distressing complication in dialysis patients, often disrupting treatment sessions and, in some cases, leading to early termination of dialysis. To explore whether magnesium levels could play a role in this issue, the investigators evaluated 62 stable ESRD patients receiving maintenance hemodialysis. Each participant completed two in-person surveys within six months, both administered by the same nephrology fellow to maintain consistency.During the first assessment phase, patients were dialyzed using a dialysate magnesium concentration of 0.75 meq/L (0.375 mmol/L). Before the second survey, the magnesium concentration in the dialysate was increased to 1.0 meq/L (0.50 mmol/L). Patients rated the intensity of muscle cramps on a 1 to 10 scale, with higher scores indicating more severe symptoms. The study led to the following findings:The proportion of patients reporting muscle cramps decreased from 77% to 56% after increasing dialysate magnesium concentration.The mean severity score of muscle cramps improved from 5.34 ± 3.61 to 3.89 ± 3.94.Early termination of dialysis due to cramps occurred in 23% of patients on lower magnesium dialysate, while no patients on higher magnesium dialysate ended sessions early.Increasing dialysate magnesium did not significantly affect interdialytic weight gain, ultrafiltration volume, dry weight, or episodes of intradialytic hypotension.The authors acknowledged several limitations. The cramp severity scale used in the survey was not formally validated, and recall bias may have influenced patient responses. Additionally, the study was not originally designed specifically to assess the impact of dialysate magnesium on cramping or serum magnesium levels but instead capitalized on a change in dialysis protocol.Overall, the findings suggest that increasing dialysate magnesium concentration may reduce muscle cramping and improve adherence to dialysis sessions. Nonetheless, the researchers emphasize the need for larger, well-designed studies to confirm both the effectiveness and long-term safety of this strategy in patients with ESRD undergoing hemodialysis.Reference:Lynch, P. G., Abate, M., Suh, H., & Wadhwa, N. K. (2013). Magnesium and Muscle Cramps in End Stage Renal Disease Patients on Chronic Hemodialysis. Advances in Nephrology, 2014(1), 681969. https://doi.org/10.1155/2014/681969