People living with kidney failure often face distressing symptoms like insomnia, restless legs syndrome (RLS), cramps, and pain. A recent survey of kidney care units in Australia, New Zealand, and the UK aimed to uncover how these symptoms are treated in real-world settings. The study showed wide variation in medication choices, suggesting a need for stronger evidence and more consistent guidelines. Here are some key findings on how insomnia, RLS, cramps, and pain are managed across these countries.*

Insomnia and Restless Legs Syndrome

Among the symptoms studied, insomnia had the highest diversity in treatment approaches. 

• Melatonin was the most common first choice, followed by the sleep aids zolpidem and zopiclone. 
• In Australia, melatonin and mirtazapine were more common, while the UK leaned toward using zolpidem and zopiclone. 
• Benzodiazepines were used more frequently in the UK, even though there is little evidence for their safety and effectiveness in kidney patients.

RLS treatment was more consistent across the board. Iron replacement therapy was the top first-line treatment in nearly 70% of responding centers. Gabapentinoids and dopamine agonists were also widely used, though in varied positions in the treatment process. 

These drugs have more clinical evidence to support their use, which may explain the lower variation in practice. Some minor therapies, like vitamins C and E, were rarely used, even though small studies suggest they might help.

Cramps and Pain: A Patchwork of Preferences

When it came to muscle cramps, treatment choices varied by country. 

• Australia and New Zealand commonly use magnesium and an herbal supplement called Crampeze.
• The UK relies more on quinine, yet its use is controversial due to the potential side effects. 

There is a noticeable lack of strong studies supporting any of these treatments, which may contribute to the scattered approaches.

For pain management, there was more agreement among providers, especially for neuropathic (nerve-related) pain. Gabapentinoids like gabapentin were the leading choices, followed by older antidepressants like amitriptyline. But opioid use for other types of pain showed more diversity. 

Oxycodone was the most common opioid, but preferences for drugs like fentanyl, buprenorphine, and hydromorphone varied widely. 

Differences in national drug policies and costs likely play a role in shaping these patterns.

Moving Toward Better Symptom Relief

This international study offers a clearer picture of how kidney care teams manage four common and burdensome symptoms: insomnia, RLS, cramps, and pain. Among the treatments, some stood out for their consistent use and relative effectiveness.

• For RLS. Iron supplementation remains the most widely supported and commonly used first-line treatment. 
• For RLS and neuropathic pain. Gabapentinoids like gabapentin are favored due to stronger evidence of benefit. 
• For insomnia. Melatonin is the most frequently chosen first-line therapy, though its long-term effectiveness remains uncertain. 
• For cramps. Magnesium is a popular option in some regions, though the overall evidence is limited, and practices vary widely.

Because there are still many unanswered questions and inconsistencies in treatment, it’s essential for patients with kidney failure to speak directly with their healthcare providers. Open conversations can help tailor symptom management to individual needs and ensure that care decisions are based on the best available evidence. 

As research continues, both patients and providers will be better equipped to manage these challenging symptoms more safely and effectively.

*Nalankilli, K., Stallworthy, E., Ducharlet, K., Hole, B. D., et al. (2025, April 23). Treatment of insomnia, restless legs, cramps, and pain associated with chronic kidney disease: results from a multinational survey of kidney supportive care practice. BMC Nephrology 26. https://doi.org/10.1186/s12882-025-04107-1 

To ensure that we always provide you with high-quality, reliable information, Responsum Health closely vets all sources. We do not, however, endorse or recommend any specific providers, treatments, or products, and the use of a given source does not imply an endorsement of any provider, treatment, medication, procedure, or device discussed within.