Frequency Of Cramps Research Articles

Interventions for leg cramps in pregnancy.

Interventions for leg cramps in pregnancy.

Treatment of nocturnal leg cramps by blockade of the medial branch of the deep peroneal nerve after lumbar spine surgery.

IntroductionPatients with lumbar spine disease sometimes complain of nocturnal leg cramps. We sought to investigate the effectiveness of blocking the medial branch of the deep peroneal nerve as treatment for nocturnal leg cramps after spinal surgery for lumbar spine disease.MethodsWe evaluated 66 postoperative patients in this prospective comparative study of a group of patients with a nerve block (n = 41) and a control group without (n = 25). In the block group, the medial branch of the deep peroneal nerve was blocked at the distal two-thirds of the interspace between the first and second metatarsals using 5.0 mL of 1.0% lidocaine.ResultsTwo weeks after the block, the frequency of nocturnal leg cramps was reduced to less than a quarter of pretreatment baseline frequency in 61.0% of patients (n = 25) and less than half in 80.5% (n = 33). In the control group, the frequency of the leg cramps was reduced from baseline in 32.0% of patients (n = 8), and was unchanged or increased in 68.0% (n = 17) at 2 weeks. Cramp frequency was reduced to less than a quarter or less than half of baseline frequency in a significantly (P < 0.05 and P < 0.01, respectively) larger percentage of patients in the block group. The severity of each cramp was less in about two-thirds of patients (63.4%; n = 26) in the block group and was unchanged in one-third (31.7%; n = 13).ConclusionsBlocking the medial branch of the peroneal nerve can be an effective, long-lasting, and simple treatment with low risk for nocturnal cramps sustained after lumbar spine surgery.

Muscle Cramps During Hemodialysis: What can we Do? New Approachs for Treatment and Preventing

Muscle cramps are the most prevalent intradialytic complication and an important difficulty for patients. The frequency of muscle cramps is about 35-86% during haemodialysis. Excessive ultrafiltration, intradialytic hypotension, electrolyte-mineral disturbances , hypoosmolality are the most frequent causes. Muscle cramps can be treated by isotonic-hypertonic saline or hypertonic dextrose solutions. Also, preventing hypotension, profiling sodium, vitamin E and C can be used to prevent. There are new advances to treat and prevent this inconvenience, and we aimed to rewiev the causes and approachs for treatment and preventing muscle cramps during hemodialysis.

The Effects of Myofascial Trigger Point Injections on Nocturnal Calf Cramps

The purpose of this study was to elucidate the effects of injection at trigger points on pain and sleep disturbance in patients with nocturnal calf cramps (NCCs). Patients with NCCs that occurred at least once per week and who had myofascial trigger points (MTrPs) on the gastrocnemius muscles were enrolled in the study for 9 months. At the first visit (T0), we measured the intensity of NCC pain on an 11-point numeric rating scale, recorded the frequency of NCCs, and calculated the Insomnia Severity Index (ISI). We then checked for MTrPs on the gastrocnemius muscles and injected 1-2 mL of 0.25% lidocaine into each of the trigger points. At 1 (T1), 2 (T2), and 4 (T3) weeks after the first visit, we repeated the process performed at T0. Twelve patients completed the treatment schedule and attended the follow-up visits. Mean values of the numeric rating scale pain score, frequency of cramps, and ISI declined significantly at T1, T2, and T3 compared with baseline (all P < .01). Of 12 patients, 10 had clinical insomnia before treatment, and this number decreased significantly to 3 patients at T2 and 1 patient at T3 (P = .012 and P = .001, respectively). These preliminary data show that injection at MTrPs in patients with NCCs not only alleviated pain and reduced the frequency of cramps but also lessened the severity of insomnia as measured by the ISI. A larger randomized controlled trial is needed to confirm these findings and determine whether the effect lasts over the long term.

L-carnitine Reduces Muscle Cramps in Patients With Cirrhosis

We performed a prospective study to evaluate the ability of L-carnitine, which is involved in the β-oxidation of fatty acids, to reduce muscle cramps in patients with cirrhosis. Consecutive patients with cirrhosis and muscle cramps were given L-carnitine 300 mg, 3 times/day (900 mg/day, n= 19) or 4 times/day (1200 mg/day, n= 23) for 8 weeks. The frequency of muscle cramps was assessed by questionnaires, and the degree of muscle cramping was assessed by using the visual analogue scale (VAS). Muscle cramping was reduced in 88.1% of all subjects at the end of the 8-week study period and disappeared for 28.6% of patients. Overall VAS scores decreased significantly from 69.9 ± 22.5 at baseline to 26.2 ± 29.1 after 8 weeks (P<.0001). The dose of L-carnitine was significantly associated with percentages of patients with reduced muscle cramps after 8 weeks (43.5% in the 1200 mg/day group vs 10.5% in the 900 mg/day group, P= .037) and VAS scores at 8 weeks (9.9 ± 13.5 in the 1200 mg/day group vs 39.6 ± 31.9 in the 900 mg/day group, P= .003). No adverse events were reported. Therefore, L-carnitine appears to be safe and effective for reducing liver cramps in patients with cirrhosis.

Magnesium and Muscle Cramps in End Stage Renal Disease Patients on Chronic Hemodialysis

We evaluated the frequency and severity of muscle cramps, and the effect of dialysate magnesium on muscle cramps in 62 stable ESRD patients on chronic hemodialysis. Each subject was surveyed twice within a 6-month period. A single nephrology fellow conducted all in-person surveys. During the first survey, the patients were dialyzed with dialysate magnesium of 0.75 meq/L (0.375 mmol/L). Prior to the second survey, the dialysate magnesium was increased to 1.0 meq/L (0.50 mmol/L). The severity of cramps was scored on a 1–10 scale, with 10 indicating maximal severity. The number of patients with muscle cramps was significantly lower with dialysate magnesium of 1.0 meq/L (0.50 mmol/L) (56% versus 77%,P=0.02). No significant difference was observed in interdialytic weight gain, intradialytic ultrafiltration, dry weight, or intradialytic hypotension. The mean ± SD severity score of muscle cramps decreased from5.34±3.61to3.89±3.94(P=0.003). Seven of 31 (23%) patients in the group with low dialysate magnesium while 0/20 (0%) patients receiving high magnesium dialysate terminated hemodialysis early due to cramps (P=0.02). Both the number of patients reporting muscle cramps and the severity score decreased with higher dialysate magnesium which contributed to better adherence to hemodialysis treatments.

Systematic review: the treatment of muscle cramps in patients with cirrhosis.

Up to 88% of patients with hepatic cirrhosis experience painful muscle cramps resulting in sleep deprivation and impaired quality of life. Management is often based on poor evidence with varying degrees of success in controlling the frequency and severity of muscle cramps in this group. To review systematically the treatment options for muscle cramps in cirrhosis. A systematic review of the relevant databases to identify treatments for muscle cramps in patients with hepatic cirrhosis was performed. Studies meeting the selection criteria were reviewed and quality of the papers was rated using a validated quality rating scale. The results for each treatment are reported. Eighteen publications were identified as eligible for inclusion in this systematic review. The majority (n = 15) of these were treatment/intervention reports. Only three randomised-control studies were identified. A wide range of treatments were identified including zinc, 1-α-hydroxy vitamin D, vitamin E, branched chain amino acids, taurine, l-carnitine, nuiche-shen-qi-wen, eperisone hydrochloride, intravenous albumin and quinidine. There were some reported improvements in muscle cramps with most interventions with the exception of vitamin E but the evidence predominantly relies on case study reports. There is a lack of randomised-controlled clinical studies to support using these interventions. There appear to be a number of promising treatments for muscle cramps in cirrhosis. However, there remains a need for further double-blinded, randomised, controlled clinical investigations to support routine use of these interventions to treat muscle cramps in patients with hepatic cirrhosis.

Efficacy of a massage roller combined with cooling lotion in the prevention of calf muscle cramps

ZusammenfassungIn dieser offenen Anwendungsbeobachtung wurde an 208 Patienten über 4 Wochen geprüft, ob die Kombination des Massagerollers mit der Waden Massage Pflegelotion die Anzahl der Waden- und Fußkrämpfe senken kann. Zur Prophylaxe wurden täglich über mindestens 5 Minuten die betroffenen Muskeln ausgehend von der Großzehe in Rich-tung der Leiste mit dem Massageroller mit mäßig bis mittelstarkem Druck ausgerollt. Bei 151 Patienten zeigte sich eine deutliche Besserung, indem die Frequenz der Wadenkrämpfe um mehr als die Hälfte abnahm bzw. keine Wadenkrämpfe mehr auftraten. Auch die Krampflänge nahm durch Anwendung des Massagerollers bei einem aktuellen Wadenkrampf ab. Die Häufigkeit und Stärke wurde in einem Fragebogen dokumentiert. Schwangere, jüngere Patienten, solche mit Venenerkrankungen und Männer in jedem sowie Frauen im mittleren Alter profitierten von der Anwendung des Massagerollers am besten.

Incidence of Nocturnal Leg Cramps in Patients with Lumbar Spinal Stenosis before and after Conservative and Surgical Treatment

PurposeTo examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS.Materials and MethodsThe subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment.ResultsThe severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122).ConclusionThe findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.

An effective stretching regimen to prevent nocturnal leg cramps

Last year we published a randomised trial demonstrating that stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults (Hallegraeff et al 2012). The results of that study align perfectly with the uncontrolled study of Daniell (1979). In a recent letter to this journal, Daniell and Pentrack (2013) proposed an alternative stretching procedure for preventing nocturnal leg cramps. Some major differences can be identified between their new stretching procedure and the procedure used in our study.

Comparison of vitamin e and L-carnitine, separately or in combination in patients with intradialytic complications.

BackgroundThe most common complications during dialysis are hypotension and muscle cramps. There are many strategies to prevent and treat these complications.ObjectivesThe aim of this study is to evaluate effects of vitamin E and L-carnitine supplementation alone and in combination on intradialytic complications.Patients and MethodsIn a prospective study, 20 patients with end stage renal disease on chronic hemodialysis that had intradialytic complications such as hypotension, muscle cramp, nausea, vomiting and headache were studied. These patients were studied in four 45 day periods, beginning with no treatment (step 1), receiving vitamin E (200 IU/d) (step 2), receiving L-carnitine (500 mg/d) (step 3) and their combination (step 4). Intradialytic complications were recorded in each step and compared between treatments.ResultsAll three treatments significantly reduced frequency of muscle cramps in comparison to baseline values. Vitamin E alone and in combination with L-carnitine reduced the frequency of muscle cramps more effectively. Hypotension was significantly lower in combination therapy in comparison to baseline values and vitamin E treatment.ConclusionsVitamin E and L-carnitine both have comparative effects on intradialytic complications. As the combination use of vitamin E and L-carnitine could more effectively reduce the intradialytic complications, it is recommended for daily use in hemodialysis patients.

Impact of Dry Weight Determined by Calf Bioimpedance Ratio on Carotid Stiffness and Left Ventricular Hypertrophy in Hemodialysis Patients

Our previous study has shown that modification of bioimpedance technique by the measurement of bioimpedance ratio in the calf (calf-BR) was a simple and practical method in assessing fluid status in hemodialysis patients. However, the consequences of periodical dry weight (DW) adjustment under the guidance of calf-BR on target organ damage have not been investigated. One hundred fifteen hemodialysis patients were enrolled in this pilot trial. Patients were divided into bioimpedance group and control group according to their dialysis schedule. In the bioimpedance group, DW was routinely adjusted under the guidance of calf-BR every 3 months. In the control group, the assessment of DW remained a clinical judgment. Carotid stiffness, left ventricular mass index (LVMI), and calf-BR were measured at baseline and at the 12th month in both groups. Home blood pressure (BP) was monitored monthly. Episodes of dialysis-related adverse events were recorded. No significant differences were observed in parameters between the two groups at baseline. Compared with the control group, the bioimpedance group had significantly lower values in terms of the annual averages of systolic home BP (147.4 ± 15.3 mm Hg vs. 152.6 ± 16.9 mm Hg, P = 0.019), carotid stiffness index β (10.7 ± 3.3 vs. 12.2 ± 3.1, P = 0.003), LVMI (155.21 ± 15.64 g/m(2) vs. 165.17 ± 16.76 g/m(2) , P < 0.001), and the percentage of individuals with calf-BR over target range (P = 0.040) at month 12, with less annual averages of antihypertensive medications used and lower frequency of intradialytic hypotension, muscle cramps, or clotted angioaccess. Continued DW control achieved by periodical calf-BR measurement improved arterial stiffness and left ventricular hypertrophy with good tolerability in hemodialysis patients.

Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial

How effective is the vaginal administration of misoprostol in dilating the cervix prior to inserting an intrauterine device (IUD) in nulligravidas? The use of misoprostol at a dose of 400 µg administered vaginally 4 h prior to IUD insertion increased the ease of insertion and reduced the incidence of pain during the procedure, although the frequency of cramps increased following misoprostol use. Misoprostol has been widely used in Obstetrics and Gynecology; however, its usefulness and efficacy in facilitating IUD insertion in nulligravidas have yet to be established. The present study shows that the benefits of misoprostol use prior to IUD insertion include facilitating insertion and reducing pain during the procedure; therefore, weighing up the benefits encountered against the only negative side effect (cramps prior to insertion), these results suggest that misoprostol use should become standard practice to facilitate IUD insertion in nulligravidas. A randomized, double-blind clinical trial was conducted. Nulligravid women of reproductive age were submitted to IUD insertion between July 2009 and November 2011 at the Instituto de Medicina Integral Prof. Fernando Figueira in Recife, Pernambuco, Brazil. A total of 179 women were randomly allocated to two groups: 86 to receive 400 µg of misoprostol vaginally 4 h prior to IUD insertion and 93 to receive placebo. Risk ratios (RRs) were calculated as measures of relative risk, together with their 95% confidence intervals (95% CI). The number needed to treat (NNT) and the number needed to harm (NNH) were also calculated. Significant differences were found between the groups for all the immediate end points studied, with less difficulty in inserting the IUD [RR = 0.49 (23/86 versus 51/93); 95% CI: 0.33-0.72; P = 0.00005], a lower risk of dilatation <4 mm [RR = 0.48 (24/86 versus 54/93); 95% CI: 0.33-0.70; P = 0.0001], a reduction in moderate-to-severe pain at IUD insertion [RR = 0.56 (32/86 versus 62/93]; 95% CI: 0.41-0.76; P = 0.00008), as well as a lesser likelihood of experiencing a disagreeable or very disagreeable sensation [RR = 0.49(29/86 versus 64/93); 95% CI: 0.35-0.68; P = 0.000004] in the group that was given misoprostol compared with the group that received placebo. There was no significant difference between the groups in relation to complications during IUD insertion. There were no cases of uterine perforation in either group. The frequency of cramps was 40% higher in the misoprostol group. The present study showed a positive balance between the benefits and risks of the use of misoprostol; however, it is not feasible to conclude that its use is imperative prior to IUD insertion in nulligravidas and IUD insertion should not be canceled when the medication is unavailable. In view of its effect in promoting cervical dilatation, misoprostol may be used prior to IUD insertion both in nulligravidas and in any women with cervical stenosis irrespective of parity. This study was funded by the Instituto de Medicina Integral Prof Fernando Figueira. None.

Associations between anthropometric and sleep parameters among adolescents: considerations by gender

Background: The purpose of this study was to examine the associations between anthropometric (e.g., body mass index, waist circumference) and sleep parameters (e.g., sleep latency, sleep duration, frequency of leg cramps and snoring while sleeping) in boy and girl adolescents. Methods: Data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were used with a sample of 339 NHANES adolescent participants between 16 and 17 years of age examined in the analysis. Anthropometric data was measured with sleep parameters self-reported. Results: In general, girls with higher levels of anthropometric indices slept for longer durations. For girls, those with higher levels of anthropometric indices were more likely to snore and have leg cramps. No associations were significant for boys. Conclusion: The results from this study suggest that, for girls, unfavorable levels of anthropometric indices may negatively influence quality of sleep.

Magnesium for skeletal muscle cramps

Skeletal muscle cramps are common and often presented to physicians in association with pregnancy, advanced age, exercise or disorders of the motor neuron (such as amyotrophic lateral sclerosis). Magnesium supplements are marketed for the prophylaxis of cramps but the efficacy of magnesium for this indication has never been evaluated by systematic review. To assess the effects of magnesium supplementation compared to no treatment, placebo control or other cramp therapies in people with skeletal muscle cramps. We searched the Cochrane Neuromuscular Disease Group Specialized Register (11 October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (2011, Issue 3), MEDLINE (January 1966 to September 2011), EMBASE (January 1980 to September 2011), LILACS (January 1982 to September 2011), CINAHL Plus (January 1937 to September 2011), AMED (January 1985 to October 2011) and SPORTDiscus (January 1975 to September 2011). Randomized controlled trials (RCTs) of magnesium supplementation (in any form) to prevent skeletal muscle cramps in any patient group (i.e. all clinical presentations of cramp). We considered comparisons of magnesium with no treatment, placebo control, or other therapy. Two authors independently selected trials for inclusion and extracted data. Two authors assessed risk of bias. We attempted to contact all study authors and obtained patient level data for three of the included trials, one of which was unpublished. All data on adverse effects were collected from the included RCTs. We identified seven trials (five parallel, two cross-over) enrolling a total of 406 individuals amongst whom 118 cross-over participants additionally served as their own controls. Three trials enrolled women with pregnancy-associated leg cramps (N = 202) and four trials enrolled idiopathic cramp sufferers (N = 322 including cross-over controls). Magnesium was compared to placebo in six trials and to no treatment in one trial.For idiopathic cramps (largely older adults presumed to have nocturnal leg cramps), differences in measures of cramp frequency, magnesium versus placebo, were small, not statistically significant, and without heterogeneity (I(2) = 0%). This includes the primary endpoint, percentage change from baseline in the number of cramps per week at four weeks (-3.93%, 95% confidence interval (CI) -21.12% to 13.26%, moderate quality evidence) and the difference in the number of cramps per week at four weeks (0.01 cramps/week, 95% CI -0.52 to 0.55, moderate quality evidence). The percentage of individuals experiencing a 25% or better reduction in cramp rate from baseline was also no different, being 8% lower in the magnesium group (95% CI -28% to 12%, moderate quality evidence). Similarly, no statistically significant difference was found at four weeks in measures of cramp intensity (moderate quality evidence) or cramp duration (low quality evidence).Meta-analysis was not possible for trials of pregnancy-associated leg cramps. The single study comparing magnesium to no treatment failed to find statistically significant benefit on a three-point ordinal scale of overall treatment efficacy. The two trials comparing magnesium to placebo differed in that one trial found no benefit on frequency or intensity measures while the other found benefit for both.Withdrawals due to adverse events were not significantly different than placebo. While we could not determine the number of subjects with minor adverse events, studies of oral magnesium generally described potential side effects as similar in frequency to placebo. It is unlikely that magnesium supplementation provides clinically meaningful cramp prophylaxis to older adults experiencing skeletal muscle cramps. In contrast, for those experiencing pregnancy-associated rest cramps the literature is conflicting and further research in this patient population is needed. We found no randomized controlled trials evaluating magnesium for exercise-associated muscle cramps or disease state-associated muscle cramps (for example amyotrophic lateral sclerosis/motor neuron disease).

Oral magnesium for relief in pregnancy‐induced leg cramps: a randomised controlled trial

Leg cramps are common in pregnant women. Currently, there is no standard treatment for pregnancy-induced leg cramps. The objective of this study was to evaluate the therapeutic efficacy of oral magnesium in pregnant women with leg cramps. This double-blinded, randomised, placebo-controlled trial included 86 healthy pregnant women, 14-34 weeks of gestation who had leg cramps at least twice per week. The study period was 4 weeks. Eighty women completed the study. Forty-one women were assigned to magnesium bisglycinate chelate (300 mg per day) and 39 women to placebo. Details of leg cramps were recorded before beginning the treatment and the fourth week of study. Outcome measure was the reduction of cramp frequency after treatment and cramp intensity measured by 100-mm visual analogue scale. Fifty per cent reduction of cramp frequency was significantly higher in the magnesium group than the placebo group (86.0% vs. 60.5%, P=0.007). The 50% reduction of cramp intensity was also significantly higher in the treatment group than in the placebo group (69.8% vs. 48.8%, P=0.048). There were no significant differences between the two groups in terms of side effects such as nausea and diarrhoea. These results demonstrated that oral magnesium supplement can improve the frequency and intensity of pregnancy-induced leg cramps. Therefore, oral magnesium may be a treatment option for women suffering from pregnancy-induced leg cramps.

Prevalence and Morbidity Associated with Muscle Cramps in Patients with Cirrhosis

PurposePatients with cirrhosis often experience muscle cramps with varying severity. We investigated the factors associated with the prevalence and morbidity associated with muscle cramps. MethodsA total of 150 adult patients with cirrhosis were enrolled consecutively. Cramp questionnaire with visual analogue scale for pain, Chronic Liver Disease Questionnaire (CLDQ), and blood for measurement of 25-(OH) vitamin D levels were obtained after informed consent. ResultsA total of 101 patients (67%) reported muscle cramps in the preceding 3 months. Patients with cramps had significantly lower serum albumin (3.1±0.6 g/dL vs 3.3±0.7 g/dL, P=.04) and CLDQ scores (107±37 vs 137±34, P<.0001) compared with those without cramps. The median composite symptom score, defined as product of frequency and severity of cramps, in the study cohort was 12 with a range of 0.3 to 200. There were no clinical or biochemical predictors for occurrence of any cramps or severe cramps (composite symptom score>12). Muscle cramps (P<.001) and hepatic encephalopathy (P=.009) were associated independently with decreased CLDQ scores. Vitamin D deficiency was seen in 66% of the study cohort, but the serum 25-(OH) vitamin D levels were not significantly different between patients with and without cramps (18.0±8.9 ng/mL vs 19.6±9.5 ng/mL, P=.49). ConclusionsMuscle cramps are associated with significantly diminished quality of life in patients with cirrhosis. More research is needed to better understand their mechanism to develop effective treatment.

Individualized reduction in dialysate sodium in conventional in‐center hemodialysis

Recent studies have focused on the association between dialysate sodium (Na(+)) prescriptions and interdialytic weight gain (IDWG). We report on a case series of 13 patients undergoing conventional, thrice-weekly in-center hemodialysis with an individualized dialysate Na(+) prescription. Individualized dialysate Na(+) was achieved in all patients through a stepwise weekly reduction of the standard dialysate Na(+) prescription (140 mEq/L) by 2-3 mEq/L until reaching a Na(+) gradient of -2 mEq/L (dialysate Na(+) minus average plasma Na(+) over the preceding 3 months). Interdialytic weight gain, with and without indexing to dry weight (IDWG%), blood pressure, and the proportion of treatments with cramps, intradialytic hypotension (drop in systolic blood pressure >30 mmHg) and intradialytic hypotension requiring an intervention were reviewed. At the beginning of the observation period, the pre-hemodialysis (HD) plasma Na(+) concentration ranged from 130 to 141 mEq/L. When switched from the standard to the individualized dialysate Na(+) concentration, IDWG% decreased from 3.4% ± 1.6% to 2.5% ± 1.0% (P = 0.003) with no change in pre- or post-HD systolic or diastolic blood pressures (all P > 0.05). We found no significant change in the proportion of treatments with cramps (6% vs. 13%), intradialytic hypotension (62% vs. 65%), or intradialytic hypotension requiring an intervention (29% vs. 33%). Individualized reduction of dialysate Na(+) reduces IDWG% without significantly increasing the frequency of cramps or hypotension.

Sa1029 Acute Kidney Injury (AKI) Predicts Mortality in Hospitalized Patient With Cirrhosis

Background/Aims:Muscle cramps are common in patients with cirrhosis, particularly when diuretics are used for ascites. Its pathophysiologic mechanism remains uncertain. In this work, we conducted field testing of a questionnaire to measure the extent and severity of muscle cramps in patients with cirrhosis and explored plasma metabolomic biomarkers for muscle cramps. Methods: Patients with an established diagnosis of cirrhosis were prospectively contacted prior to their follow-up appointment in our liver clinic. Patients were asked to fill out a muscle cramps questionnaire (mMCQ) which asks about occurrence, frequency, location and impact (sleep and daily living) of muscle cramps. Blood samples were drawn after a minimum of 12 hours of fasting, which were promptly cold-centrifuged and plasma was separated for metabolomics assays. Results: In this on-going study, 109 patients have been contacted to date, of whom 46 patients have responded to the questionnaire (response rate=42% to date). The respondents were 57.8 ± 11.1 years of age and 59% were men. The mean MELD score was 12.8 ± 5.5. Approximately half (46%) reported history of hepatic encephalopathy and 6.5% refractory ascites requiring therapeutic paracentesis. In this patient cohort, the prevalence of muscle cramps was 76%. Of those who reported muscle cramps, 50% had moderate to severe symptoms (occuring at least daily or causing at least moderate disturbance of activities of daily living). To date, we have assayed 25 amino acid in the plasma samples (n=43), including taurine, threonine, serine, asparagine, glutamic acid, argininosuccinic acid, glutamine, proline, glycine, alanine, citruline, α-amino-N-butyric acid, valine, cysteine, methionine, isoleucine, leucine, tyrosine, phenyl alanine, β-alanine, ornithine, lysine, histidine, arginine, and allo-isoleucine. Of these, plasma cysteine levels were significantly different according to the severity of muscle cramps. In patients without muscle cramps the median plasma level was 59 nmol/mL with an interquartile range (IQR) of 52-75 nmol/mL, compared to those with cramps (median=82 nmol/mL, IQR=61-94). In the figure, patients with severe cramps had the highest cysteine levels (median 90 nmol/ mL, IQR=78-106) compared to those with mild cramps (median:73 nmol/mL, IQR=51-86). Conclusion: Muscle cramps are extremely common in patients with cirrhosis receiving ongoing care at a liver clinic. Plasma cysteine levels may be a potential biomarker for muscle cramps, as they correlate with their occurrence and severity.

Sa1027 Plasma Cysteine Levels and Muscle Cramps in Patients With Cirrhosis

Background/Aims:Muscle cramps are common in patients with cirrhosis, particularly when diuretics are used for ascites. Its pathophysiologic mechanism remains uncertain. In this work, we conducted field testing of a questionnaire to measure the extent and severity of muscle cramps in patients with cirrhosis and explored plasma metabolomic biomarkers for muscle cramps. Methods: Patients with an established diagnosis of cirrhosis were prospectively contacted prior to their follow-up appointment in our liver clinic. Patients were asked to fill out a muscle cramps questionnaire (mMCQ) which asks about occurrence, frequency, location and impact (sleep and daily living) of muscle cramps. Blood samples were drawn after a minimum of 12 hours of fasting, which were promptly cold-centrifuged and plasma was separated for metabolomics assays. Results: In this on-going study, 109 patients have been contacted to date, of whom 46 patients have responded to the questionnaire (response rate=42% to date). The respondents were 57.8 ± 11.1 years of age and 59% were men. The mean MELD score was 12.8 ± 5.5. Approximately half (46%) reported history of hepatic encephalopathy and 6.5% refractory ascites requiring therapeutic paracentesis. In this patient cohort, the prevalence of muscle cramps was 76%. Of those who reported muscle cramps, 50% had moderate to severe symptoms (occuring at least daily or causing at least moderate disturbance of activities of daily living). To date, we have assayed 25 amino acid in the plasma samples (n=43), including taurine, threonine, serine, asparagine, glutamic acid, argininosuccinic acid, glutamine, proline, glycine, alanine, citruline, α-amino-N-butyric acid, valine, cysteine, methionine, isoleucine, leucine, tyrosine, phenyl alanine, β-alanine, ornithine, lysine, histidine, arginine, and allo-isoleucine. Of these, plasma cysteine levels were significantly different according to the severity of muscle cramps. In patients without muscle cramps the median plasma level was 59 nmol/mL with an interquartile range (IQR) of 52-75 nmol/mL, compared to those with cramps (median=82 nmol/mL, IQR=61-94). In the figure, patients with severe cramps had the highest cysteine levels (median 90 nmol/ mL, IQR=78-106) compared to those with mild cramps (median:73 nmol/mL, IQR=51-86). Conclusion: Muscle cramps are extremely common in patients with cirrhosis receiving ongoing care at a liver clinic. Plasma cysteine levels may be a potential biomarker for muscle cramps, as they correlate with their occurrence and severity.