Association of blood urea levels with myoclonic jerks in patients with end-stage renal disease on maintenance hemodialysis: a cross-sectional study

Objective This study aimed to investigate the blood urea threshold level that triggers myoclonic jerks in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) and evaluated the mediating role of the length of chronic kidney disease (CKD) in this neurological complication. Methods A cross-sectional study was conducted on ESRD patients undergoing hemodialysis at Evercare Hospital in Dhaka, Bangladesh, from April-July 2024. The presence of myoclonus was documented before and after hemodialysis, along with blood urea levels. Unadjusted and adjusted multivariate associations with pre-HD myoclonus were estimated using modified Poisson regression with robust standard errors to obtain crude and adjusted prevalence ratios (cPRs and aPRs, respectively). Results Among the 101 participants, pre-hemodialysis myoclonic jerks were present in 36 (35.64%). Diabetes and hypertension were reported by 75.25% and 90.10%, respectively. Patients with each additional year since CKD diagnosis showed a 27% higher prevalence of pre-hemodialysis myoclonus (aPR 1.27; 95% CI 1.18–1.48; p = 0.001); whereas, a longer interval from CKD diagnosis to first hemodialysis was associated with a 20% lower prevalence (aPR 0.80; 95% CI 0.69–0.93; p = 0.004). Although aPRs of pre-HD myoclonus were elevated across all higher pre-HD blood urea level categories, none of these increases reached statistical significance ( p > 0.05). Conclusion The prevalence of myoclonus rises with increasing pre-dialysis blood urea levels, yet no specific threshold could be identified. A longer duration of CKD is associated with a greater prevalence of myoclonus, while socio-demographic factors show no significant effect, highlighting the complex nature of this condition. Trial registration Not applicable.