Impact of Ramadan fasting on eGFR in patients with late stage chronic kidney disease

Year 2023, Volume: 6 Issue: 5, 1016 - 1021, 28.09.2023

Mahmud İslam

https://doi.org/10.32322/jhsm.1330331

Cited By: 1

Abstract

Aims: Ramadan fasting is a significant religious practice observed annually by approximately 1.9 billion adult Muslims worldwide. However, its potential impact on kidney health in individuals with chronic kidney disease (CKD) remains a subject of concern. This study aimed to investigate the effects of Ramadan fasting on renal function in patients with stage 3-5 CKD and to identify any associated risk factors.
Methods: A single-center, self-controlled longitudinal observational study was conducted on 192 stable patients with stage 3-5 CKD who observed Ramadan fasting. The fasting period was about 14-15 hours per day for one month Various clinical parameters, including eGFR, blood urea nitrogen (BUN), sodium (Na+), potassium (K+), calcium (Ca++), phosphorus, parathyroid hormone (PTH), albumin, uric acid, fasting glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and hemoglobin (Hgb), were measured before and after Ramadan fasting. P<0.05 was assumed significant.
Results: The study results demonstrated no significant deterioration in eGFR during Ramadan fasting (pre-Ramadan: 43.54±11.04 vs post-Ramadan: 44.28±11.51, p=0.063). Additionally, traditional risk factors for CKD progression, such as diabetes mellitus (DM), hypertension (HT), cardiovascular disease CVD, and age, did not show a significant association with eGFR changes during fasting (p>0.05). Furthermore, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) did not impact eGFR (0.084). Notably, Ramadan fasting led to improvements in metabolic parameters, such as fasting glucose and lipid profile, except for triglyceride levels (p<0.001).
Conclusion: The study results indicate that Ramadan fasting does not appear to have adverse effects on kidney function in individuals with CKD, although certain metabolic changes were observed.

Keywords

Ramadan fasting, chronic kidney disease, glomerular filtration rate, metabolic parameters, kidney function

Thanks

The author would like to thank Prof. Dr. Hamad Dheir for ideas and suggestions for improving the manuscript. Great thanks to my nurses: Betul Turkoglu and Sonay Boz, for their assistance in organizing and supervising the study population. Finally, warm thanks to Medical secretery Ayşe Karagülmez for her organiztion efforts in our nephrogy outpatient clinic .

References

• El-Wakil HS, Desoky I, Lotfy N, Adam AG. Fasting the month of Ramadan by Muslims: Could it be injurious to their kidneys? Saudi J Kidney Dis Transpl. 2007;18(3):349.
• Mbarki H, Tazi N, Najdi A, Tachfouti N, Arrayhani M, Sqalli T. Effects of fasting during Ramadan on renal function of patients with chronic kidney disease. Saudi J Kidney Dis Transpl. 2015;26(2):320-324. doi:10.4103/1319-2442.152494
• Al Muhanna FA. Ramadan fasting and renal failure. Saudi Med J. 1998;19(3):319-321.
• Hassan S, Hassan F, Abbas N, et al. Does Ramadan Fasting Affect Hydration Status and Kidney Function in CKD Patients? Ann Nutr Metab. 2018;72(3):241-247. doi:10.1159/000486799
• 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.
• The future of the global Muslim population. Pew Research Center’s Religion & Public Life Project. Published January 27, 2011. Accessed July 26, 2023. Available at: https://www.pewresearch.org/religion/2011/01/27/the-future-of-the-global-muslim-population/
• Demir ME. Böbrek hastaları ve oruç ibadeti. Med Princ Pract. 2018;1(2):45-46. doi:10.32322/jhsm.400011
• Hassanein M, Al-Arouj M, Hamdy O, et al. Diabetes and Ramadan: practical guidelines. Diabetes Res Clin Pract. 2017;126:303-316.
• Nazzal Z, Hamdan Z, Masri D, Abu-Kaf O, Hamad M. Prevalence and risk factors of chronic kidney disease among Palestinian type 2 diabetic patients: a cross-sectional study. BMC Nephrol. 2020;21(1):484. doi:10.1186/s12882-020-02138-4
• Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310(9):959-968. doi:10.1001/jama.2013.184182
• Habas E Sr, Errayes M, Habas E, et al. Fasting Ramadan in chronic kidney disease (CKD), kidney transplant and dialysis patients: review and update. Cureus. 2022;14(5): e25269.
• Turkish Society of Nephrology, 2019 annual registry; available from https://nefroloji.org.tr/uploads/folders/file/registry_2019.pdf Accessed: 19.07.2023
• Kara E, Sahin OZ, Kizilkaya B, et al. Fasting in Ramadan is not associated with deterioration of chronic kidney disease: a prospective observational study. Saudi J Kidney Dis Transpl. 2017;28(1):68-75. doi:10.4103/1319-2442.198140
• NasrAllah MM, Osman NA. Fasting during the month of Ramadan among patients with chronic kidney disease: renal and cardiovascular outcomes. Clin Kidney J. 2014;7(4):348-353.
• Emami-Naini A, Roomizadeh P, Baradaran A, Abedini A, Abtahi M. Ramadan fasting and patients with renal diseases: a mini review of the literature. J Res Med Sci. 2013;18(8):711-716.
• Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. Fasting Ramadan in chronic kidney disease patients: clinical and biochemical effects. Saudi J Kidney Dis Transpl. 2010;21(5):898-902.
• Einollahi B, Lessan-Pezeshki M, Pourfarziani V, et al. Ramadan fasting in kidney transplant recipients with normal renal function and with mild-to-moderate renal dysfunction. Int Urol Nephrol. 2009;41(2):417-422. doi:10.1007/s11255-008-9476-y
• Ansari FA, Latief M, Manuel S, et al. Impact of fasting during Ramadan on renal functions in patients with chronic kidney disease. Indian J Nephrol. 2022;32(3):262-265.
• Abdullah M, Wahyudi ER, Nugroho P, Alfian A. Kidney function profile before, during, and after Ramadan fasting in healthy elderly: a prospective cohort study. Med J Indonesia. 2022;31(2):115-119.
• Eldeeb AA, Mahmoud MA, Ibrahim AB, Yousef EA, Sabry AA. Effect of Ramadan fasting on arterial stiffness parameters among Egyptian hypertensive patients with and without chronic kidney disease. Saudi J Kidney Dis Transpl. 2020;31(3):582-588.
• Chowdhury A, Khan H, Lasker SS, Chowdhury TA. Fasting outcomes in people with diabetes and chronic kidney disease in East London during Ramadan 2018: The East London diabetes in Ramadan survey. Diabetes Res Clin Pract. 2019; 152:166-170.
• Akaberi A, Golshan A, Moojdekanloo M, Hashemian M. Does fasting in Ramadan ameliorate Lipid profile? a prospective observational study. Pak J Med Sci Q. 2014;30(4):708-711.
• Akhtar P, Kazmi A, Sharma T, Sharma A. Effects of Ramadan fasting on serum lipid profile. J Family Med Prim Care. 2020;9(5):2337-2341. doi:10.4103/jfmpc.jfmpc_550_19
• Darzabi T, Hejazi K. The effects of Ramadan fasting on electrolytes index, serum osmolarity and body composition in fasting and non-fasting students: A quasi-experimental study. Jundishapur J Chronic Dis Care. 2020;9(2). doi:10.5812/jjcdc.100079