Fasting Ramadan and Kidney Diseases
Dr. Umber Afia
Nephrology and Transplant
Baylor Grapevine and Presbyterian Hospital, Dallas
Dr. Anas Bassam Bernieh
Assistant Professor of Pathology
Cincinnati Children’s Hospital, and University of Cincinnati.
Dr. Ahmad Anjak
Associate Professor of Medicine
University of Cincinnati, Department of Medicine, Division of nephrology
Introduction
Chronic kidney disease (CKD) is a common term indicating kidney damage due to various reasons.
The most common causes of CKD include diabetes, hypertension, analgesic abuse, congestive heart failure, glomerulonephritis, and systemic diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis, and others.
In clinical practice, volume depletion or reduced renal perfusion is the most common cause of acute kidney injury especially in vulnerable patients.
Fasting in Ramadan requires no eating or drinking for almost 12+ hours and poses a potential risk of acute kidney injury in patients with already compromised kidney function.
What Do We Know About Fasting In CKD?
We did an extensive review of several studies done on CKD patients who fasted during the month of Ramadan.
We found that most of the studies have a small sample size of less than one hundred patients.
High-risk patients were excluded from the studies.
Most of the studies fail to find a significant decline in kidney function with fasting.
Those who showed worsening kidney function were mainly hypotensive during fasting, were elderly that are above 70 years old, and were volume depleted.
Studies showing a decline in kidney function with fasting failed to show any difference in the non-fasting CKD group. This may mean that the decline in kidney function in the fasting group may be just CKD progression rather than fasting.
There are small studies that show improved kidney functions, reduction in proteinuria, and better blood pressure control in the fasting population with an increase in blood-urea-nitrogen (BUN) in the last 7 days of Ramadan. BUN returned to normal after the month of Ramadan.
All the studies recommended regular evaluation by the nephrologist if the patient is planning to fast and have medications adjusted especially to avoid hypotension and hypoglycemia.
Positive Effects of Fasting on The Patient’s Health
It is known that mild food restriction leads to multisystemic beneficial effects and activates cellular stress response pathways to protect cells and tissues from damage.
It protects against ischemic insults in organs like the liver, heart, brain, and kidneys.
One study demonstrated that fasting protects the rat kidney against oxidative stress and mitochondrial dysfunction in early acute kidney injury and against fibrosis development.
General Recommendations and Precautions
Kidney disease, dialysis, or transplant patients planning to fast should have a detailed discussion with the nephrologist before Ramadan.
They should have a clear understanding of their medications, what to eat, and when it is important to break the fast.
Table 1 attempts to classify the possible effects of fasting and clinical situations into the following three categories:
Safe Conditions: Do not pose any health risk to the patient and medically is safe to fast.
Conditions With Uncertain Risk: Variable risks and cannot make common recommendations. Patients need to discuss with the physician.
Likely Harmful Conditions: Fasting poses clear health risks to the patients and better medically NOT to fast.
When To Stop Fasting?
Patients should stop fasting if creatinine is elevated from base line by 0.2-0.3 mg/dl, weight loss or gain due to volume overload is noticed, any electrolyte imbalance noted especially high or low sodium, potassium, excessive weakness, or sleepiness etc.
What To Eat?
Eating a healthy diet is essential for patients with CKD.
It is recommended to maintain a low salt diet during Iftar, and to get 2.5- 3 liters of water during Iftar hours, avoid licorice for patients with moderate to advanced CKD due to water retention. Avoid foods high in potassium and phosphorus.
An appointment with the dietician is very helpful in getting education regarding the different foods people usually eat in Suhoor and Iftar.
It is important to know the glycemic index, and caloric value of dates, fruits, and others.
Figs, olives, and barley are considered to be good for kidneys.
Baking soda is helpful in CKD patients if their blood pressure is not uncontrolled.
Cumin is a helpful spice in reducing blood pressure and proteinuria.
About Medications
Table 2: Scheduling medications during fasting
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