Background <p>Intradialytic muscle cramps disrupt hemodialysis (HD), trigger rescue interventions, and reduce patient comfort. Evidence for preventive, nurse-led strategies is limited. This study evaluated whether a standardized intradialytic stretching protocol reduces cramp burden compared to usual care.</p> Methods <p>A single-center, parallel-group randomized controlled trial was conducted. Adults on maintenance HD with a history of leg cramps were randomized 1:1 to nurse-led stretching (<i>n</i> = 30) or usual care (<i>n</i> = 30). The intervention included supervised lower-limb stretches, twice weekly for ~ 8 weeks, with fidelity monitoring. Outcomes were assessed using the Arabic Muscle Cramp Severity and Characteristics Questionnaire. The primary outcome was post-intervention cramp intensity category.</p> Results <p>Groups were comparable at baseline. Post-intervention, the study group showed significantly lower cramp intensity: no cramps in 83.3% vs. 30.0% of controls (<i>p</i> &lt; 0.001). Cramp frequency, duration, pain, and discomfort all favored the intervention (all <i>p</i> &lt; 0.01). Leg temperature perception did not differ. No serious adverse events occurred.</p> Conclusions <p>A brief, nurse-led stretching protocol produced large reductions in cramp burden without disrupting workflow. Integrating standardized stretching into routine nursing care is a feasible, low-cost strategy for proactive symptom management, empowering nurses and enhancing patient comfort. Multicenter, longer-term evaluations are warranted.</p> Clinical trials <p>The trial is registered at ClinicalTrials.gov under identifier NCT07262879.</p> Registration date <p>12/02/2025.</p>