Abstract: Muscle cramps are among the most distressing and frequently reported complications experienced by patients undergoing hemodialysis, significantly affecting treatment tolerance, patient comfort, and overall quality of life. These cramps are often associated with rapid fluid removal, intradialytic hypotension, and electrolyte imbalances. Nurses play a pivotal role in the prevention, early recognition, and management of muscle cramps through effective fluid management strategies. This review article explores the pathophysiology of muscle cramps during hemodialysis and critically examines nursing-led fluid management interventions aimed at reducing their occurrence. Emphasis is placed on individualized fluid assessment, ultrafiltration control, interdialytic weight management, patient education, and evidence-based nursing practices. The article highlights current research, clinical guidelines, and future directions, underscoring the essential role of nurses in optimizing dialysis outcomes through patient-centered fluid management strategies.