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Chronic kidney disease patients need close monitoring during Ramadan fast

Clinical Kidney Journal
Reuters Health - 19/02/2021 - Muslims with chronic kidney disease who wish to fast during Ramadan should undergo an evaluation to determine any needed medication changes and develop plans to monitor renal function and electrolytes while fasting, some clinicians advise.

A clinical evaluation, ideally a month before the start of Ramadan, is necessary to assess whether patients with chronic kidney disease (CKD) can safely abstain from food and drink from dawn to dusk, particularly in temperate regions where Ramadan spans summer months and the fasting period can be up 20 hours, the authors note. Their paper, published in the Clinical Kidney Journal, details best practices for managing these patients.

"CKD patients wishing to fast may be able to do so safely with the correct monitoring, predicated on an appropriate and timely pre-Ramadan review of such patients," said lead author Dr. Shafi Malik of the University Hospitals of Coventry and Warwickshire NHS Trust in the UK.

Particularly close attention must be paid to patients with comorbidities or who are on dialysis and at increased risk for dehydration, worsening kidney function and depletion of electrolytes, Dr. Malik said by email.

"We would recommend health care professionals to discuss options such as trial fasting a month before Ramadan to assess safety as well as discuss options such as winter fasting or feeding the poor instead of fasting in those who are at very high risk of complications," Dr. Malik added.

Patients on peritoneal dialysis who do proceed with Ramadan fasting may also need to change the timing of dialysis and consider limiting their maximum fasting duration to 16 hours a day, Dr. Malik said.

In an assessment tool Dr. Malik and colleagues developed in conjunction with healthcare professionals, risk for fasting is stratified based on the severity of kidney disease and individual patients' risk of complications.

Patients in earlier stages of chronic kidney disease who are in good general health, for example, may be able to fast for the entire duration of Ramadan while monitoring for symptoms of dehydration and potentially altering their medications, the researchers note.

However, patients on dialysis are at higher risk for complications and may want to consider fasting only on days when they don't undergo dialysis treatments or fasting for a limited time during Ramadan, the researchers also advise.

"If a person has severe CKD, prolonged fasting may increase their risk of developing end stage renal disease, which requires dialysis treatment," said Dr. Tahseen A. Chowdhury, a diabetes consultant at the Royal London Hospital who wasn't involved in the current paper.

Higher-risk patients may want to consider alternatives to fasting such as paying a charitable donation or fasting during the winter season when days are shorter, limiting the hours patients go without food or drink, Dr. Chowdhury said by email.

For those who do fast during Ramadan, clinicians must stress the importance careful monitoring and drinking plenty of fluids at the end of fasting each day to ensure that the kidneys fully recover, Dr. Chowdhury added.

However, the American Diabetes Association recommends against fasting during Ramadan for people with chronic kidney disease whether or not they are on dialysis, said Dr. Mahmoud Ibrahim, director of the EDC Center for Diabetes Education in McDonough, Georgia.

"There is no significant evidence indicating that some of those people could fast safely since the risk is always there and the risk is increased as the disease progresses or if patients are already on dialysis," Dr. Ibrahim, who wasn't involved in the current paper, said by email. "If you choose to fast, then you need careful pre-Ramadan assessment and close monitoring during Ramadan, but fasting is not recommended."

SOURCE: https://bit.ly/3dtronq Clinical Kidney Journal, online February 5, 2021.

By Lisa Rapaport

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