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I have cramps and I'm itchy, what is going on?

Kidney Disease

Having kidney issues or being on dialysis is challenging enough but having muscle cramps or having itching skin (puritis) is just annoying if not outright drivers to distraction. I know what you’re going through as I have had both of these issues when I was on dialysis and even before I was on dialysis, and I found some good applications for the problems having been trained as a medical naturopath for some natural applications.

OK what’s the deal with the itching? Itching can be caused be several factors: 1) high phosphorus levels 2) High sulphate levels 3) Low essential fatty acids 4) high inflammatory cytokines like IL-6 5) uremic toxins and/or food sensitivities due to the gut being affected by the uremic toxins.

How do I deal with it?

OK here are some ideas that worked for me as well as many of the patients I have seen

1) If your phosphorus is high you have to decrease your intake of it. Foods like chocolate, beans and legumes, milk products, sodas especially the dark ones, baking goods that might have phosphorus binders, even pancake mix tends to have high phosphorus. Or you may need a phosphors binder that you take with your meal.

2) High sulfates are part of having low clearance because the kidneys are not clearing the sulfates. Foods high in sulphates are sulphur containing foods like garlic, onions, chives, leeks, broccoli, cauliflower, cabbage, kale, Brussels sprouts, turnips, bok choy and kohlrabi, eggs are high in it too. There are two remedies I have found good for itching over the years they are a) the homeopathic remedy sulphur and the homeopathic remedy Rhus-tox. Try the Sulphur first especially if the itching is worse with water application and you scratch until you bleed and seems to be better with cold water or cold wind. Take the 30ch table 1/day for 3 days to see if it works or the Rhus-tox 30ch especially if your skin gets small fluid filled vesicles. If your nephrologist says that it doesn’t work ask them how much they have studied homeopathy, it worked wonders for me.

3) Low essential fatty acids: Several studies have shown that taking fish oil; 1-2 grams/day may help itching but it may take some time. Take on an empty stomach a couple times a day, its great for a lot of things and best taken with a fat soluble antioxidant like vitamin E (small amount say 200i.u. or vitamin A 10,000 i.u every 3 days). note that most dieticians and nephrologists will tell you to stay away from vitamin A however it is still an essential component the body needs and its true, once kidneys are compromised its hard for the body to get rid of it but that’s why you take it only every 3rd day and take it only for about 1 month, its great for skin. Zinc works well with essential fatty acids I usually recommend 25mg every 3rd day, if you have itchy scalp think yeast in gut or selenium deficiency (200mcg every 3rd day)

4) High inflammatory cytokines like interleukin -6 is well know to cause itching e.g. in certain types of leukemias one of the only signs is itching for no known reason, this is due to high levels of interleukin-6 (IL-6), multiple myeloma may present with this too. When in kidney failure or on dialysis IL-6 can elevate and cause a lot of issues like itching. I use one really well known herb which is proven to decrease IL-g and that is Tumeric (curcumin) or Andrographis paniculata, cats claw, generally I start with 500mg/day of curcumin standardized at 95% curcuminoids, there are others but this is simple, affordable and accessible. Its a great herb taken before dialysis as well to help decrease the oxidative stress from hemodialysis.

5) Uremic toxins like indoxyl-2-sulphate or cresol and others can be formed in the gut so my patients usually go on a gut "cleansing" protocol to try and get toxins out that way seeing that the kidneys aren’t doing their job. There are certain probiotics that help, one great combo is called Renadyl by Kibow, you can use others basic probiotics too however renadyl is designed to specifically get rid of urmeic toxins. Other treatments may be activated charcoal or something called chitosan. They basically bind toxins and you evacuate them out, you will also need to possibly limit your protein intake, however if you are on dialysis make sure your getting enough protein!

6) Stimulating the liver or "cooling" the liver; a traditional chinese medical term can help with itching. Herbs like dandelion root, burdock, bitter tasting foods, may help support the livers detoxification properties and thus help the itching because its overloaded with toxins that the kidneys are not getting out.

OK, this is it in a nut shells. Here is the over view:

1) Low phosphorus diet and/or phosphorus binders

2) Low sulphate foods or the homeoepathic remedies sulphur or rhus-tox

3) Essential fatty acids 1-2 garms per day with fat soluble antioxidant (although some studies show that this does not work)

4) Supplement with zinc and/or selenium...make sure your not taking high doses of calcium or magnesium cause they can cause itching too.

5) Herbs like Tumeric, andrographis, cats claw decrease IL-6

6) Use the gut to get rid of toxins by using probiotics, activated charcoal, chitosan

7) Make sure you are well hydrated!

8) Stop any dehydrating applications like drying soaps

9) Try topical flax oil, or olive oil or coconut oil with a mix of vitamin E and A

10) treat/stimulate your liver to help get rid of toxins

11) Iron treatments can cause inflammation and thus itching

What about Cramps?

One of the main reasons for cramping is dehydration, lack or minerals, poor oxygen content or nerve damage or possible lack of the amino acid carnitine.

I have found dehydration to be a main culprit in cramping. make sure, if you are on dialysis you are not having too much water taken off. Sometimes they take too much off even though the nurses are staying within what is normally called for, however not everyone is created equal and you need to tell them not to take too much water off especially if you are still peeing. The rule of thumb is that your allowable intake is 750ml plus the amount you are peeing out. So, if you pee 1 liter out you are allowed 1,750 ml of intake of fluid per day. Dehydration can also cause arrythmias too, so make sure your getting enough fluid in and not too much is taken off if on dialysis.

Magnesium tends to be under prescribed as, like vitamin A, and is seen as a problem because if you take too much in it can build up because your kidneys cant get rid of it very efficiently. However!, the RDA of magnesium for kidney folk with end-stage renal disease or on dialysis is 250mg/day, so you may need a little top up especially if you have low intake, take drugs that reduce absorbtion or gut issues that cause poor absorption. i usually try 150mg of magnesium citrate/day (make sure you dont take too much cause it can build up) and see if this helps.

Poor oxygen content i.e. anemia may cause cramping too. If you are on erythropoietin and you still have anemia or your hemoglobin isn’t where it should be then you probable have anemia of chronic disease which is another topic, but I will cover it soon, just make sure your not taking too much iron as this may make it worse.

Stop any caffeinated drinks and try about 500-1000mg of carnitine 2 hours before dialysis as hemodialysis removes carnitine. Quinine is usually given by doctor which tends to work pretty good if not look into the other options i have mentioned.

If you have athersclerosis you may need to do a whole protocol for that just try and get some exercise to get the blood to your legs and thus oxygen.

If your taking quinine you should look at this:

Narita, I., et al. Uremic pruritus in chronic hemodialysis patients. J Nephrology, 2008;21:161- 165.

Jae Yeon Chun, et al. Andrographolide, an Herbal Medicine, Inhibits Interleukin-6 Expression and Suppresses Prostate Cancer Cell Growth. Genes Cancer. 2010 Aug; 1(8): 868–876.

Ranganathan, et al. Probiotic dietary supplementation in patients with stage 3 and 4 chronic kidney disease: a 6-month pilot scale trial in Canada.Curr Med Res Opin. 2009 Aug;25(8):1919-30.

Siddhartha S. Ghosh, et al. Curcumin and Chronic Kidney Disease (CKD): Major Mode of Action through Stimulating Endogenous Intestinal Alkaline PhosphataseMolecules 2014, 19, 20139-20156.

Subash C. Gupta, et al. Therapeutic Roles of Curcumin: Lessons Learned from Clinical Trials. AAPS J. 2013 Jan; 15(1): 195–218.

Anurag Kuhad. Effect of Curcumin on Inflammation and Oxidative Stress in Cisplatin-Induced Experimental Nephrotoxicity. J. Agric. Food Chem., 2007, 55 (25), pp 10150–10155.

Begum, et al. Supplementation with n-3 and n-6 polyunsaturated fatty acids: Effects on lipoxygenase activity and clinical symptoms of pruritus in hemodialysis patients. Journal of renal nutrition, October 2004Volume 14, Issue 4, Pages 233–241.

Nosratola,DV. et al. Oral activated charcoal adsorbent (AST-120) ameliorates CKD-induced intestinal epithelial barrier disruption. Am J Nephrol. 2013; 37(6): 518–525.

Jing SB, et al. Effect of chitosan on renal function in patients with chronic renal failure. J Pharm Pharmacol. 1997 Jul;49(7):721-3.

By Dr. Quinn Rivet B.Sc., ND