The aim of the study was to define the features, prevalence, and pathophysiology of
therapy for
muscle cramps in cirrhotic patients. The first protocol study included 294 cirrhotic patients and 194 age- and sex-matched controls. Controls were defined as inpatients or outpatients without any clinical and laboratory evidence of
liver disease. Features and prevalence of
muscle cramps were defined on the basis of a standard questionnaire. As far as the pathophysiological associations of
muscle cramps were concerned, the following parameters were evaluated: mean arterial pressure (MAP), nutritional status, liver function tests, plasma volume (PV), plasma
renin activity (PRA), and
electrolyte,
mineral, and
acid-base status. The prevalence of
cramps was higher in cirrhotic patients than in controls, and it was related to the duration of recognized
cirrhosis and to the severity of liver function impairment. At a multiple regression analysis, the presence of
ascites, low values of MAP, and high values of PRA were the independent predictive factors for the occurrence of
cramps in
cirrhosis. In the second protocol study, the effects of a sustained expansion of the effective circulating volume induced by
intravenous infusion of
human albumin were compared with those of a placebo in 12 cirrhotic patients with more than three
cramp crises a week. Compared with the placebo,
albumin reduced the
cramp frequency (P < .01). In conclusion, an increased prevalence of true
muscle cramps occurs in patients with
cirrhosis. Our data indicate that the pathophysiological link between
cirrhosis and
cramps may be represented by the reduction of the effective circulating volume. They also indicate that weekly infusion of
human albumin may be an effective treatment for
cramps in
cirrhosis.