Effects of fasting on patients with chronic kidney disease during Ramadan and practical guidance for healthcare professionals

Malik, Shafi; Bhanji, Amir; Abuleiss, Husham; Hamer, Rizwan; Shah, Shahzad H; Rashad, Rafaqat; Junglee, Naushad; Waqar, Salman; Ghouri, Nazim

There are an estimated 1.8 billion Muslims worldwide, with the majority of them choosing to fast during the month of Ramadan. Fasting, which requires abstinence from food and drink from dawn to sunset can be up to 20 hours duration during the summer months in temperate regions. Fasting can especially be challenging in patients on haemodialysis and peritoneal dialysis, moreover, there is concern that those with Chronic Kidney Disease can experience electrolyte imbalance and worsening of renal function. In this paper, current literature is reviewed and a decision-making management tool has been developed to assist clinicians in discussing the risks of fasting in patients with CKD, with consideration also given to circumstances such as the COVID-19 pandemic. Our review highlights that patients with CKD wishing to fast should undergo a thorough risk assessment ideally within a month before Ramadan, they may require medication changes and a plan for regular monitoring of renal function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low/moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the ‘Very high risk’ and ‘High Risk’ categories should be encouraged to explore alternative options to fasting, those in the low/moderate category may be able to fast safely with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick day rules, instructions on when to terminate their fast or abstain from fasting.