Children who receive hemodialysis (a treatment that cleans their blood when their kidneys don’t work) often experience bone and muscle pain. Researchers studied 50 children at a hospital in Egypt to understand why this happens. They found that 64% of these children had bone or muscle pain, with weak bones and muscle cramps being the most common problems. The study discovered that the balance of calcium and phosphate in the blood, along with vitamin D levels, were the biggest reasons why kids experienced this pain. Understanding these connections could help doctors better prevent and treat pain in children undergoing this important kidney treatment.

The Quick Take

  • What they studied: Why children receiving hemodialysis (a blood-cleaning treatment for kidney failure) develop bone and muscle pain
  • Who participated: 50 children receiving hemodialysis treatment at a children’s hospital in Egypt between December 2022 and January 2024
  • Key finding: About 2 out of 3 children (64%) on hemodialysis experienced bone or muscle pain. The main causes were weak bones (64%), muscle pain (64%), muscle cramps (60%), and joint pain (32%). The balance of calcium and phosphate in their blood was the strongest predictor of who would have pain.
  • What it means for you: If your child receives hemodialysis, doctors should monitor their calcium and phosphate levels closely and check vitamin D status regularly. This may help prevent or reduce bone and muscle pain, improving your child’s comfort and quality of life during treatment.

The Research Details

This was a cross-sectional study, which means researchers looked at a group of children at one point in time and collected information about their health, blood work, and bone strength. They gathered information about how long each child had been receiving dialysis, what other health conditions they had, how much pain they experienced, and results from special X-ray scans that measure bone strength (called DEXA scans). They then compared children who had bone and muscle pain with those who didn’t to find patterns and connections.

The researchers collected detailed information including basic patient information, how long each child had been on dialysis, blood test results, physical function assessments, and quality of life questionnaires. They used a special test called DEXA to measure bone density and strength. This approach allowed them to identify which factors were most strongly connected to bone and muscle pain in this group of children.

This research approach is important because it helps identify which factors doctors should focus on when caring for children on dialysis. By looking at many children at the same time and comparing those with and without pain, researchers can spot patterns that might not be obvious otherwise. This information helps doctors know what to monitor and potentially prevent problems before they become serious.

This study was conducted at a major children’s hospital with proper medical oversight. The researchers collected comprehensive information including blood tests and bone density measurements, which are objective measures rather than just asking children how they feel. However, because this was a snapshot study at one hospital, the results may not apply to all children everywhere. The study size was moderate (50 children), which is reasonable but not extremely large. The findings suggest important connections but don’t prove that one thing directly causes another.

What the Results Show

Nearly two-thirds of the children studied (64%) experienced bone or muscle pain while receiving hemodialysis. The most common problems were weak bones (osteoporosis or osteopenia) and muscle pain, each affecting 64% of children with MSK pain. Muscle cramps were also very common, occurring in 60% of children with pain. Joint pain and regional pain areas affected about one-third of the children.

When researchers looked at what caused the pain, they found several important connections. Children who had been on dialysis longer were more likely to have pain. Children with other health conditions alongside their kidney disease were more likely to experience pain. The balance of calcium and phosphate in the blood was particularly important—when this balance was off, children were more likely to have pain. Vitamin D levels were also strongly connected to pain, with lower vitamin D linked to more pain.

Blood hemoglobin levels (which measure oxygen-carrying capacity) and uric acid levels also showed connections to pain, though calcium-phosphate balance and vitamin D were the strongest predictors. The bone density measurements from the DEXA scans also correlated with pain levels, showing that children with weaker bones tended to have more pain.

The study found that how well children could function physically and their overall quality of life were closely tied to whether they had bone and muscle pain. Children with pain reported lower quality of life scores and had more difficulty with physical activities. The presence of other health conditions (comorbidities) made pain more likely, suggesting that children with multiple health challenges face compounded difficulties. The research also showed that the longer children had been receiving dialysis, the more likely they were to develop bone and muscle pain, indicating this is a problem that may worsen over time without intervention.

Previous research has shown that children on dialysis are at risk for bone problems due to how dialysis affects mineral balance in the body. This study confirms and expands on those findings by specifically identifying calcium-phosphate balance and vitamin D as the most critical factors. The high prevalence of bone and muscle pain (64%) is consistent with other studies showing that musculoskeletal problems are common in children with kidney disease. This research adds to our understanding by showing how specific blood chemistry factors directly relate to pain levels.

This study looked at children at only one hospital in Egypt, so the results may not apply to all children everywhere or in different healthcare settings. The study was relatively small (50 children), which limits how much we can generalize the findings. Because it was a snapshot study rather than following children over time, we can see which factors are connected to pain but cannot prove that one thing directly causes another. The study doesn’t tell us whether treating the calcium-phosphate imbalance or vitamin D deficiency would actually reduce pain—that would require a different type of study where some children receive treatment and others don’t.

The Bottom Line

Based on this research, doctors should regularly monitor calcium and phosphate levels in children receiving hemodialysis and maintain appropriate vitamin D levels. These appear to be the most important modifiable factors connected to bone and muscle pain. Regular bone density screening using DEXA scans may help identify children at risk. Pain management strategies should be part of routine dialysis care. However, these are suggestions based on associations found in this study—more research is needed to prove that treating these factors will definitely reduce pain. (Confidence level: Moderate—good evidence of connection, but not yet proven to prevent pain through treatment)

This research is most relevant to children receiving hemodialysis, their parents, and their medical teams. Nephrologists (kidney doctors) and dialysis center staff should use this information to guide monitoring and care. Children with other kidney conditions may also benefit from similar monitoring. This research is less directly relevant to children with healthy kidneys or those with kidney disease not yet requiring dialysis, though it highlights the importance of preventing kidney disease progression.

Bone and muscle pain in children on dialysis develops gradually over months to years of treatment. Improvements in calcium-phosphate balance and vitamin D levels might reduce pain over weeks to months, but bone strength improvements typically take several months to become noticeable. Parents should not expect immediate pain relief but should work with their medical team on long-term management strategies.

Want to Apply This Research?

  • Track weekly pain levels (0-10 scale) in specific areas: bones, muscles, and joints. Also log dialysis session duration and any changes in medication or supplements. This helps identify patterns between pain and treatment factors.
  • Work with your child’s dialysis team to monitor and optimize calcium, phosphate, and vitamin D levels. If recommended, ensure consistent vitamin D supplementation and follow dietary guidelines for calcium and phosphate intake. Use the app to remind your child to take supplements and to track any pain changes.
  • Monthly review of pain patterns alongside lab results for calcium, phosphate, and vitamin D. Set reminders for regular DEXA bone density scans as recommended by your child’s doctor. Track whether pain improves as mineral levels normalize, and share this data with your medical team to guide treatment adjustments.

This research describes associations found in one study of 50 children at a single hospital. It does not prove cause-and-effect relationships and should not be used to replace medical advice from your child’s doctor. If your child receives hemodialysis and experiences bone or muscle pain, discuss these findings with their nephrologist or dialysis care team. Any changes to treatment, supplements, or diet should only be made under medical supervision. This information is educational and not a substitute for professional medical diagnosis or treatment.