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Boobes Y, Afandi B, AlKindi F, Tarakji A, Al Ghamdi SM, Alrukhaimi M, Hassanein M, AlSahow A, Said R, Alsaid J, Alsuwaida AO, Al Obaidli AAK, Alketbi LB, Boubes K, Attallah N, Al Salmi IS, Abdelhamid YM, Bashir NM, Aburahma RMY, Hassan MH, Al-Hakim MR. Consensus recommendations on fasting during Ramadan for patients with kidney disease: review of available evidence and a call for action (RaK Initiative). BMC Nephrol 2024; 25:84. [PMID: 38448807 PMCID: PMC10916266 DOI: 10.1186/s12882-024-03516-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
Ramadan fasting (RF) involves abstaining from food and drink during daylight hours; it is obligatory for all healthy Muslims from the age of puberty. Although sick individuals are exempt from fasting, many will fast anyway. This article explores the impact of RF on individuals with kidney diseases through a comprehensive review of existing literature and consensus recommendations. This study was conducted by a multidisciplinary panel of experts.The recommendations aim to provide a structured approach to assess and manage fasting during Ramadan for patients with kidney diseases, empowering both healthcare providers and patients to make informed decisions while considering their unique circumstances.
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Affiliation(s)
- Yousef Boobes
- Seha Kidney Care, Tawam Hospital, Al Ain, UAE.
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE.
| | - Bachar Afandi
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
- Endocrine Division, Tawam Hospital, Al Ain, UAE
| | | | - Ahmad Tarakji
- St. George Medical Center & McMaster University-Waterloo Campus, Kitchener, ON, Canada
| | | | | | - Mohamed Hassanein
- Endocrine Section, Dubai Hospital, Dubai Health, Dubai, UAE
- Mohammed Bin Rashid University of Medicine and Health Science, Dubai, UAE
| | - Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
| | - Riyad Said
- Department of Nephrology and Medicine, Jordan Hospital and Medical Center Ibn Sina University for Medical Sciences, Amman, Jordan
| | - Jafar Alsaid
- Nephrology department, Ochsner Medical Center, New Orleans, LA, USA
| | | | | | - Latifa B Alketbi
- Ambulatory Healthcare Services - Abu Dhabi Healthcare Services, Abu Dhabi, UAE
| | - Khaled Boubes
- Department of Medicine, Ohio State University, Columbus, OH, USA
| | - Nizar Attallah
- Nephrology Associates of Kentuckiana, University of Kentucky, Louisville, USA
| | - Issa S Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
| | - Yasser M Abdelhamid
- Nephrology Division, Internal Medicine Department -Faculty of Medicine, Cairo University, Cairo, Egypt
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Bhuiyan MN, Saadiq RA, Mueller MR, Abdalrhim AD, Overgaard J. Patient Care During Ramadan: A Narrative Review. Health Serv Res Manag Epidemiol 2024; 11:23333928241266041. [PMID: 39050928 PMCID: PMC11268016 DOI: 10.1177/23333928241266041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024] Open
Abstract
Ramadan is the Islamic holy month when Muslims around the world fast from dawn to sunset. This 30-day pattern of intermittent diurnal fasting can have a significant physiologic impact on the body. Importantly, oral intake is forbidden during this time, and many patients do not wish to take medications. From a clinical perspective, this potentially impacts healthcare delivery and chronic disease states. Despite these important changes, awareness of individual patient practices remains limited among healthcare providers in North America, which may worsen health disparities in Muslim patients. A fundamental understanding of the cultural and physiological implications of fasting during Ramadan can improve cultural competence and patient outcomes. In this paper, we review the physiologic changes during fasting, medical exemptions to fasting, and special considerations for the care of Muslim patients with chronic conditions who may fast during Ramadan.
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Affiliation(s)
- M. Nadir Bhuiyan
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rayya A. Saadiq
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael R. Mueller
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmed D. Abdalrhim
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua Overgaard
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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AlSahow A. The Impact of Hot Ambient Temperature and Prolonged Fasting Duration during Ramadan on Patients with Chronic Kidney Disease: A Literature Review. Int J Nephrol 2023; 2023:2636507. [PMID: 38106546 PMCID: PMC10725313 DOI: 10.1155/2023/2636507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
The Islamic (lunar) calendar has 11 fewer days each year than the Gregorian (solar) calendar. Consequently, ambient temperatures during the month of Ramadan and the duration of the presunrise-to-sunset fast will change each year. At some point, individuals observing Ramadan will experience prolonged periods of fasting during the hot summer months. In this manuscript, findings published in the English-language medical literature that address the impact of prolonged fasting during the warmer summer months on patients with chronic kidney disease, including dialysis and transplantation patients, are reviewed. This is of particular concern given the accelerated pace of global warming. The limitations of the evidence that is currently available are also discussed, and an approach that might be used to standardize future evaluations of the impact of fasting on kidney health is suggested.
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Affiliation(s)
- Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
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Tarabeih M, Qaddumi J, Hamdan Z, Hassan M, Jebrin K, Khazneh E, Bahar S, Ahmed N, Sawalha R, Sawalmeh O. Increasing Overnight Fluid Intake and Kidney Function During Ramadan Fasting: A Randomized Controlled Trial. Transplant Proc 2023; 55:80-86. [PMID: 36549977 DOI: 10.1016/j.transproceed.2022.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/04/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND All healthy Arab individuals are obligated to abstain from eating, drinking, and sexual relations from dawn to sunset during Ramadan, which is one of the 5 pillars of Islam. Fasting effects various body systems, apart from the renal system. Fasting can also increase serum creatinine levels because of dehydration. Our aim was to examine the effects of increased fluid intake during the night on serum creatinine and urea levels. METHODS This randomized controlled trial included 58 healthy subjects who were randomly divided into 2 groups of 29. The hydrated group drank 2 to 3 L of fluid from sunset to the dawn of the next day. Kidney function was measured before, during, and 1 month after Ramadan. RESULTS After adjustment for sociodemographic variables, the control group exhibited higher means of serum concentrations of creatinine and urea and lower estimated glomerular filtration rate than the hydrated group. The Ramadan group exhibited highest means of serum levels of creatinine and urea and the lowest estimated glomerular filtration rate compared with the pre- and post-Ramadan periods. All results were statistically significant at P <.05. CONCLUSIONS We found that Ramadan fasting was not associated with a permanent increase in serum creatinine or urea. For those groups with a high fluid intake, serum creatinine and urea were significantly lower than the controls suggesting a favorable effect of hydration during the nonfasting hours. This compensated with the dehydration occurring during daylight, as dehydration is responsible for increased concentrations of urea and creatinine. This study adds further evidence that Ramadan fasting does not affect the renal system of healthy subjects; however, fluids should be increased at night, during nonfasting hours.
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Affiliation(s)
- Mahdi Tarabeih
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus.
| | - Jamal Qaddumi
- Department of Nursing, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus
| | - Zakaria Hamdan
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
| | - Mohannad Hassan
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
| | - Kamel Jebrin
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
| | - Emad Khazneh
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
| | - Sami Bahar
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
| | - Nabeel Ahmed
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
| | - Ramzi Sawalha
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
| | - Osama Sawalmeh
- Department of Nephrology, An-Najah National University Hospital, An-Najah National University, Nablus
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Habas E, Errayes M, Habas E, Farfar KL, Alfitori G, Habas AE, Rayani A, Elzouki ANY. Fasting Ramadan in Chronic Kidney Disease (CKD), Kidney Transplant and Dialysis Patients: Review and Update. Cureus 2022; 14:e25269. [PMID: 35755525 PMCID: PMC9218841 DOI: 10.7759/cureus.25269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a common disease in the Islamic regions. Dehydration occurs after prolonged fasting, particularly in hot and humid climates. In the Arabic months’ calendar, Ramadan is a month of maximum given deeds, where Muslims are required to fast from dawn till sunset. Depending on where you live and when the Ramadan month falls, fasting might last anywhere from 10 to 20 hours or more. In certain circumstances, such as poorly controlled diabetes and advanced CKD patients who are allowed to break their fast, the Ramadan fasting amendment is viable. Some Muslims, however, continue fasting despite these circumstances, placing themselves at risk, which is not allowed in the Islamic religion. There are no medical recommendations that specify who should and should not fast. Nonetheless, the recommendations have been extracted from several published studies. The authors searched EMBASE, PubMed, Google Scholar, and Google for publications, research, and reviews. All authors debate and analyze the related articles. Each author was assigned a part or two of the topics to read, study, and summarize before creating the final draft of their given section. Then this comprehensive review was completed after discussion sessions. In conclusion, by the Islamic religion view, fasting Ramadan is mandatory for every wise adult person. People who have chronic diseases or that may deteriorate by fasting are exempted from fasting. It seems that fasting and the associated disease hours are determinant factors to fasting or not fasting. Up to our knowledge, there are no established guidelines for CKD patients and physicians to follow; however, the International Diabetes Federation and Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 have been issued for CKD diabetic patients and fasting.
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AlAbdan NA, Almohammed OA, Altukhaim MS, Farooqui MA, Abdalla MI, Al Otaibi HQ, Alshuraym NR, Alghusun SN, Alotaibi LH, Alsayyari AA. Fasting during Ramadan and acute kidney injury (AKI): a retrospective, propensity matched cohort study. BMC Nephrol 2022; 23:54. [PMID: 35125093 PMCID: PMC8819932 DOI: 10.1186/s12882-022-02674-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background During the month of Ramadan, Muslims abstain from daytime consumption of fluids and foods, although some high-risk individuals are exempt. Because fasting's effects on the risk of acute kidney injury (AKI) have not been established, this study assesses the relationship between fasting and risk of AKI and identifies patients at high risk. Methods A single-center, retrospective, propensity-score matched, cohort study was conducted with data collected from adult patients admitted to the emergency room during Ramadan and the following month over two consecutive years (2016 and 2017). AKI was diagnosed based on the 2012 definition from the Kidney Disease: Improving Global Outcomes clinical practice guideline. Multivariable logistic regression analyses were used to examine the correlation and measure the effect of fasting on the incidence of AKI, and assess the effect of different variables on the incidence of AKI between the matching cohorts. Results A total of 1199 patients were included; after matching, each cohort had 499 patients. In the fasting cohort, the incidence of AKI and the risk of developing AKI were significantly lower (adjusted odds ratio (AOR) 0.65;95% confidence interval (CI) 0.44–0.98). The most indicative risk factors for AKI were hypertension (AOR 2.17; 95% CI 1.48–3.18), history of AKI (AOR 5.05; 95% CI 3.46–7.39), and liver cirrhosis (AOR 3.01; 95% CI 1.04–8.70). Patients with these factors or most other comorbidities in the fasting cohort had a lower risk of AKI as compared with their nonfasting counterparts. Conclusion The data show a strong reduction in the risk of developing AKI as a benefit of fasting, particularly in patients with comorbid conditions. Therefore, most patients with comorbid conditions are not harmed from fasting during Ramadan. However, larger prospective studies are needed to investigate the benefit of fasting in reducing the risk of developing AKI.
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Binsalih S, Al Sayyari RA, Sheikho M, Hejaili FF, Al Sayyari AA. Effect of Fasting the Whole Month of Ramadan on Renal Function Among Muslim Patients With Kidney Transplant: A Meta-Analysis. EXP CLIN TRANSPLANT 2020; 17:588-593. [PMID: 31570092 DOI: 10.6002/ect.2019.0245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Muslim renal transplant patients often ask whether fasting during Ramadan would be harmful to their kidneys. We performed a meta-analysis on relevant studies to answer this question. MATERIALS AND METHODS We searched 4 databases using comprehensive search terms with predefined eligibility criteria. Two reviewers (FH and RA) independently assessed the relevance of studies obtained during the search. If disagreement occurred, a consensus would be sought; if disagreement persisted, the arbitration would be left to a third author (AAS). RESULTS Eight studies (549 patients) were identified as eligible; these studies measured renal function before and after Ramadan with patients acting as their own controls in 5 studies. Our pooled analyses showed no significant changes after fasting with regard to estimated glomerular filtration rate (70.1 ± 9.1 vs 68.5 ± 7.5 mL/min, respectively; P = .6) or in serum creatinine levels (105.3 ± 8.8 and 106.1 ± 6.0 μmol/L, respectively; P = .47). In 4 self-controlled studies (148 patients) that had analyzed changes in systolic and diastolic blood pressure before versus after fasting, no significant differences were shown. However, in 3 studies that assessed changes in glomerular filtration rate in fasting (n = 358) versus nonfasting patients (n = 355), there was a significant difference in change in glomerular filtration rate following Ramadan fasting (-0.13 ± 1.2 mL/min in those who fasted versus 4.2 ± 4.6 mL/min in those who did not fast; P = .039); however, these results were associated with significant publication bias (systematic heterogeneity). CONCLUSIONS Fasting during Ramadan did not result in significant changes in kidney function or blood pressure in posttransplant patients with good baseline kidney function when patients acted as their own controls.
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Affiliation(s)
- Salih Binsalih
- From the King Saudi Bin Abdulaziz University for Heath Sciences, Riyadh, Kingdom of Saudi Arabia
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Li L, Su Y, Li F, Wang Y, Ma Z, Li Z, Su J. The effects of daily fasting hours on shaping gut microbiota in mice. BMC Microbiol 2020; 20:65. [PMID: 32209070 PMCID: PMC7092480 DOI: 10.1186/s12866-020-01754-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background It has recently been reported that intermittent fasting shapes the gut microbiota to benefit health, but this effect may be influenced to the exact fasting protocols. The purpose of this study was to assess the effects of different daily fasting hours on shaping the gut microbiota in mice. Healthy C57BL/6 J male mice were subjected to 12, 16 or 20 h fasting per day for 1 month, and then fed ad libitum for an extended month. Gut microbiota was analyzed by 16S rRNA gene-based sequencing and food intake was recorded as well. Results We found that cumulative food intake was not changed in the group with 12 h daily fasting, but significantly decreased in the 16 and 20 h fasting groups. The composition of gut microbiota was altered by all these types of intermittent fasting. At genus level, 16 h fasting led to increased level of Akkermansia and decreased level of Alistipes, but these effects disappeared after the cessation of fasting. No taxonomic differences were identified in the other two groups. Conclusions These data indicated that intermittent fasting shapes gut microbiota in healthy mice, and the length of daily fasting interval may influence the outcome of intermittent fasting.
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Affiliation(s)
- Linghao Li
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Yuxin Su
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Fanglin Li
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Yueying Wang
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Zhongren Ma
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Zhuo Li
- China-Malaysia National Joint Laboratory, Biomedical Research Center, Northwest Minzu University, Lanzhou, China
| | - Junhong Su
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, No.727 South Jingming Rd., Chenggong District, Kunming, China. .,Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
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Arabi Z, Ghalib B, Asmari I, Gafar M, Alam S, Abdulgadir M, AlShareef A, Rashidi A, Alruwaymi M, Altheaby A. Instructions for kidney recipients and donors (In English for medical providers and in Arabic for patients and donors). Avicenna J Med 2020; 10:41-53. [PMID: 32110549 PMCID: PMC7014992 DOI: 10.4103/ajm.ajm_120_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Medical providers are often asked by their kidney recipients and donors about what to do or to avoid. Common questions include medications, diet, isolation, return to work or school, pregnancy, fasting Ramadan, or hajj and Omrah. However, there is only scant information about these in English language and none in Arabic. Here, we present evidence-based education materials for medical providers (in English language) and for patients and donors (in Arabic language). These educational materials are prepared to be easy to print or adopt by patients, providers, and centers.
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Affiliation(s)
- Ziad Arabi
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Basmeh Ghalib
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Asmari
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Gafar
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Syed Alam
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohamad Abdulgadir
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ala AlShareef
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Awatif Rashidi
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alruwaymi
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Altheaby
- Adult Transplant Nephrology, The Organ Transplant Center at King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Ahmad S, Chowdhury TA. Fasting during Ramadan in people with chronic kidney disease: a review of the literature. Ther Adv Endocrinol Metab 2019; 10:2042018819889019. [PMID: 31798822 PMCID: PMC6859673 DOI: 10.1177/2042018819889019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/27/2019] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) is common among Muslim patients, and many such patients are keen to fast during the month of Ramadan. Fasting for prolonged periods may be deleterious for patients with CKD, but the changing season of fasting means that the duration of fast is very variable between geographical locations. There is, furthermore, a paucity of evidence to guide patients and clinicians in management of fasting in people with CKD. In this article, we aim to review the available evidence for patients with CKD and fasting, including haemodialysis and renal transplantation. We suggest that all patients with CKD should be deemed high risk or very high risk for fasting. We conclude, however, that patients with stable mild/moderate CKD (stage 1-3) may be able to fast providing they are carefully monitored and counselled. We also suggest that patients with stable renal transplants may also be able to fast, providing they are monitored carefully by their transplant team. Patients on haemodialysis or peritoneal dialysis should not be encouraged to fast, but if they do so, they will need careful weekly monitoring. There is an urgent need for high-quality data for patients with CKD who plan to fast over Ramadan, to enable more guidance to be developed for this vulnerable group of patients.
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Affiliation(s)
- Shahzaib Ahmad
- Specialist Trainee in Anaesthetics and Intensive Care, Department of Anaesthetics and Intensive Care, St Helier Hospital, London, UK
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