Ramadan fasting, a religious practice observed by millions of Muslims around the world, poses unique challenges for individuals with chronic kidney disease (CKD). While those with chronic diseases or other conditions are exempt from fasting if doing so could further harm them, many Muslim CKD patients express a desire to fast during the month of Ramadan. A recent review of diverse studies provides insights into the impact of Ramadan fasting on CKD patients, along with evidence-based recommendations to support CKD patients wishing to fast during Ramadan.*

Health considerations during fasting

There’s significant variability in renal responses to fasting among people with CKD, encompassing concurrent medical issues, medication regimens, and other individual factors. That said, there are broad health considerations that all CKD patients who wish to fast should be aware of. 

• Renal function stability. Numerous studies demonstrate that Ramadan fasting does not adversely affect renal function in CKD patients, provided there is careful monitoring and medical guidance. Studies consistently show stable renal function, and even some benefits to fasting, such as lower incidences of acute kidney injury.
• Cardiovascular health and metabolic regulation. Insights from recent studies suggest that Ramadan fasting does not negatively impact arterial stiffness, chronic inflammation, or body composition in CKD patients, indicating a favorable safety profile from a cardiovascular and metabolic standpoint.
• Hydration and electrolyte balance. Adequate hydration, including strategic fluid consumption and attention to sodium, potassium, and phosphorus intake, is critical for CKD patients observing Ramadan fasting, to maintain electrolyte balance and prevent dehydration which, if severe, can be fatal.
• Biochemical changes and clinical implications. Ramadan fasting induces biochemical changes in CKD patients, necessitating vigilant monitoring and adjustments in treatment or dietary plans. Favorable metabolic shifts have been observed, emphasizing the importance of tailored management strategies.
• Nutritional considerations and metabolic effects. Precise nutritional management, including balanced protein, carbohydrate, and fat intake, is essential for CKD patients observing Ramadan fasting to prevent exacerbation of kidney conditions and ensure overall well-being.

Safety guidelines for fasting during Ramadan with CKD 

Ensuring the safety of CKD patients during Ramadan fasting requires a multidisciplinary approach, involving:

• Thorough pre-fasting assessments, 
• Continuous monitoring, 
• Personalized dietary guidance, and 
• Post-Ramadan follow-up. 

Risk factors impacting fasting ability, such as renal insufficiency, diabetes, and hypertension, must be carefully evaluated, and uniquely-tailored fasting guidelines based on CKD stage and individual health status are essential.

*Alobaidi, S. (2024, April 3). Ramadan Fasting and Its Impact on Patients With Chronic Kidney Disease: Insights and Guidelines. Cureus 16(4): e57522. doi:10.7759/cureus.57522. https://www.cureus.com/articles/239336-ramadan-fasting-and-its-impact-on-patients-with-chronic-kidney-disease-insights-and-guidelines#!/ 

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