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Table 2 Patient quotes regarding cramping

From: Cramping, crashing, cannulating, and clotting: a qualitative study of patients’ definitions of a “bad run” on hemodialysis

Cramping

Experience

Severe Pain in various parts of body

“A type of throbbing pain or cramp that makes a bad run for me.”

“My life is gonna be over. And I tell ya they are in my arms, in my legs. They’re in my stomach.”

“Cramping like it will break bones...pain enough to consider leaving early or not return”

Lasting Pain

“I used to cramp and I would go home…it’s a Friday, until that Sunday night sometimes or early that Monday, I wouldn’t feel relief.”

Perceived Causes

Incorrect post-dialysis target weight

“…the cramping came from my gaining weight and needing my dry weight to be increased and they were taking too much off.”

Fluid removal volume and speed

“…a bad run would be…cramping being on the machine, taking off too much fluid, too fast.”

Patients consuming too much fluid

“…I …caused a lot of problems for myself with bad runs by coming in after having drank too much in between treatments and would sit there and cramp severely.”

Low blood pressure

“Low pressure oftentimes leads to cramping. Buildup of lactic acid…hurts like hell.”

Perceived Solutions

Patient-driven

Involvement in decisions about fluid removal

 “Control fluids to avoid cramping, self-managing how much fluid is taken off in a dialogue with the tech…”

Tracking weights

 “Get a little notebook, write it down. What you weigh when you come in and what you weight when you go out. And then you start figuring it out. And you’ll have a better idea of how much fluid you’re ingesting…”

Dietary Intervention

 “…I could walk out like I’m a brand new person because that salt works. It does wonders…no chips.”

Clinician-driven

Fluid administration, dialysis session interruption

 “Received extra saline, sometimes turned off the machine, or came off the machine.”

 “they can’t give you so many fluids to stop it because it defeats the purpose of why you came to dialysis.”

Manual Intervention

 “…the nurses and technicians try. They try to massage they try to do what they can. They’re hurting from seeing people hurting… it’s very immediate. So they try what they can. But they can’t bring it down so quickly.”