skip to main content

Dry Weight Reassessment Intradialytic Cramps — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

EasyHaemodialysisDry Weight Reassessment Intradialytic CrampsESENeph

A 72-year-old man on haemodialysis has been experiencing painful muscle cramps during the last hour of each dialysis session. His dry weight was reduced by 1 kg two weeks ago. Pre-dialysis BP is 135/80 mmHg. Interdialytic weight gain is typically 3.2 kg (session frequency: 3 per week). Post-dialysis BP drops to 95/58 mmHg. What is the most appropriate initial intervention?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Reassess and increase dry weight

Intradialytic cramps with symptomatic hypotension following a recent dry weight reduction strongly suggest the target dry weight is set too low. The most appropriate initial step is to reassess and increase dry weight — likely reversing the recent reduction. Overly aggressive ultrafiltration below true dry weight causes hypovolaemia, hypotension, and cramps. Sodium profiling (increasing dialysate sodium) can help acutely but causes increased thirst and interdialytic weight gain. Midodrine is reserved for persistent intradialytic hypotension after dry weight optimisation. Reducing session time worsens adequacy.

Reference: UKKA 2019 – Haemodialysis Guidelines; Flythe et al 2011 – Intradialytic Hypotension and Mortality