Effects Of Vitamin K₂ On Muscle Cramps In Hemodialysis Patients

Objectives:Muscle cramps(muscle spasm)is one of the common complications in hemodialysis(HD)patients,but the cause and mechanism of muscle cramps in hemodialysis patients are still controversial,and there are no recognized guidelines for the prevention and treatment of muscle cramps.therefore,we carried out a prospective study to observe the relieving effect of vitamin K2 supplementation on muscle cramps in hemodialysis patients.To provide a safe and feasible method for the prevention and treatment of dialysis-related muscle cramps to lay a clinical foundation.Methods:Forty-eight maintenance hemodialysis(MHD)patients were selected from the Hemodialysis Center of the affiliated Hospital of North Sichuan Medical College.General data were collected,including sex?age?diabetes;dialysis-related indicators including dialysis age?dialysis adequacy?monthly average ultrafiltration volume?blood pressure and heart rate;Laboratory indicators include calcium(Ca2+)?sodium(Na+)?magnesium(Mg2+)?phosphorus(P)?albumin(ALB)?hematocrit(HCT)?parathyroid hormone(iPTH).According to whether the frequency of muscle cramps in hemodialysis patients was more than one time per month,Chi-square test and logistic regression analysis were used to evaluate the influencing factors of muscle cramps in hemodialysis patients.Twenty hemodialysis patients with muscle cramps more than four times per month during dialysis were given vitamin K2 supplement(180ug/d,twice a day)for a period of one year.The frequency?location?duration and pain degree of muscle cramps during dialysis were recorded before vitamin K2 supplementation(before K2),post vitamin K2 supplementation(post K2)and stop vitamin K2 supplementation(stop K2).Then statistical analysis was carried out to evaluate the improvement of muscle cramps in dialysis patients after taking vitamin K2.The whole data were processed by SPSS25.0 statistical software.The normality was tested by K-S and the homogeneity of variance was tested by Levene.The data obeying normal distribution were expressed by mean±standard deviation(x±s).The parameter test method was used when the measurement data satisfied the normal distribution and the homogeneity of variance,and the paired t test was used for the comparison between the two groups,P<0.05 showed that the difference was statistically significant.The enumeration data were analyzed by chi-square test,and the difference was statistically significant(p<0.05).The influencing factors of muscle cramps during dialysis were analyzed by logistic regression analysis,P<0.1 showed that the difference was statistically significant.Use GraphPad Prism8 software to draw statistical chart.Results:1.The incidence of muscle cramps in 48 MHD patients during dialysis was about 17.1%.The average number of muscle cramps sites was 2.35,the average duration was 6.64 minutes,and the average spasm score was 5.72.2.Compared with MHD patients with less than one time muscle cramps per month during dialysis,the influencing factors of muscle cramps in MHD patients with more than one muscle cramps per month were dialysis age?primary disease?calcium?albumin and ultrafiltration volume,P values were 0.056?0.072?0.046?0.087?0.040 respectively,and the regression coefficients were-16.659?8.141?-6.777?-6.269?10.455 respectively.3.Among the influencing factors of muscle cramps in MHD patients with more than four muscle cramps per month during dialysis,compared with those at baseline(before vitamin K2 supplementation),there was no significant change in Ca2+?ALB levels and monthly average ultrafiltration volume after taking vitamin K2 twelve months(P>0.05).4.The muscle cramps of 20 MHD patients whose frequency of muscle cramps was more than four times per month during dialysis was compared with that at baseline.After twelve months of vitamin K2 supplementation,the frequency?location?duration and score of muscle cramps decreased.The difference was statistically significant(P<0.05).5.After stopping vitamin K2 one months,the frequency?site?duration and score of muscle cramps in 20 MHD patients with more than four times of muscle cramps during dialysis were higher than those in the course of vitamin K2 supplementation,but the difference was not statistically significant(P>0.05).In the mean comparison,the duration and score of muscle cramps in dialysis patients decreased.Conclusion:1.The incidence of muscle cramps in MHD patients during dialysis is relatively low,only 17.1%.2.Low calcium?low albumin?high ultrafiltration volume and diabetes may be the influencing factors of muscle cramps in patients with MHD during dialysis.3.After supplementation of vitamin K2,the frequency?site?duration and score of muscle cramps in hemodialysis patients were reduced,and the muscle cramps was improved.4.Vitamin K2 is a safe and effective vitamin that can relieve muscle cramps in MHD patients during dialysis.