Tohoku J. Exp. Med., 2012, 227(3)

Biotin Ameliorates Muscle Cramps of Hemodialysis Patients: A Prospective Trial

SHIRO OGUMA,¹ ITIRO ANDO,² TAKUO HIROSE,³ KAZUHITO TOTSUNE,^3,4 HIROSHI SEKINO,⁵ HIROSHI SATO,² YUTAKA IMAI³ and MASAKO FUJIWARA³

¹Koujinkai Nagamachi Clinic, Sendai, Japan
²Labotratory of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
³Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
⁴Department of Social Welfare, Faculty of Synthetic Welfare, Tohoku Fukushi University, Sendai, Japan
⁵Koujinkai Central Clinic, Sendai, Japan

Patients with renal failure undergoing hemodialysis often have muscle cramps during and after the dialysis therapy. Muscle cramps are defined as the sudden onset of a prolonged involuntary muscle contraction accompanied with severe pain, resulting in early termination of a HD session and inadequate dialysis. The etiology of the cramps is unknown and effective anti-cramp medicine is not available. We have hypothesized that water-soluble vitamins are deficient in HD patients. Accordingly, we administrated biotin to 14 patients who had frequent muscle cramps during HD sessions. Oral administration of 1 mg/day biotin promptly reduced the onset and the severity of cramps in 12 patients both during and after HD. Then, the plasma biotin levels were measured by an enzyme-linked immunosorbent assay method (ELISA) in HD patients, including 14 patients with cramps and 13 patients without cramps, and 11 healthy volunteers. Plasma biotin levels were elevated in 27 HD patients at baseline compared with healthy volunteers [451 (377 - 649) vs. 224 (148 - 308) ng/l, median (lower-upper quartiles); p < 0.0001]. Unexpectedly, among the 14 cramp patients, the biotin levels were significantly higher in biotin-ineffective 7 patients than biotin-effective 7 patients [1,064 (710 - 1,187) vs. 445 (359 - 476) ng/l; p < 0.001]. Thus, the biotins measured by ELISA may consist of not only intact biotin but also its metabolites that do not function as a vitamin. In conclusion, biotin administration is one choice to relieve HD patients from muscle cramps regardless of their elevated plasma biotin levels.

keywords —— biotin; ELISA; hemodialysis; muscle cramp; vitamin

© 2012 Tohoku University Medical Press

===============================

Tohoku J. Exp. Med., 2012, 227, 217-223

Correspondence: Masako Fujiwara, Department of Planning for Drug Development and Clinical Evaluation, Graduate School of Pharmaceutical Sciences, Tohoku University, 6-3, Aramaki-aza-aoba, Aobaku, Sendai, Miyagi 980-8578, Japan.

e-mail: fmasako@m.tohoku.ac.jp