What is your approach to managing intradialytic cramping that recurs despite multiple dry weight adjustments in a patient with ESKD?

This is a great question and there is no easy answer. As always, try and make sure the patient is following fluid restriction in between treatments as having less fluid to remove during a session may reduce cramping. I also try gabapentin 100mg prior to treatment for cramping. If they treat early in the morning I have them take it the evening before dialysis. If they treat in the afternoon, have them take it in the morning. This medication can be helpful to many patients and you only use it in l...

• tonic water
• watch Mg
• sodium modeling
• slow UF or dry UF