Fasting during the month of Ramadan among patients with chronic kidney disease: renal and cardiovascular outcomes

Abstract

BackgroundFasting during the month of Ramadan is a religious obligation for Muslims who represent 20% of the world population. This study explores the safety of fasting for a whole month among patients with chronic kidney disease (CKD) with the possible risk of dehydration and hyperviscosity leading to deterioration of kidney functions and vascular thrombosis.MethodsWe followed CKD patients with stable kidney function who chose to fast during the month of Ramadan. A group of nonfasting CKD patients served as controls. Serum creatinine was recorded at the beginning of the month, after 1 week of fasting, at the end of the month and 3 months later. Patients were followed for major adverse cardiovascular events (MACE).ResultsA total of 131 CKD patients were recruited and included in two groups: fasting and nonfasting (mean baseline estimated glomerular filtration rate 27.7, SD 13 and 21.5, SD 11.8 mL/min/1.73 m2, respectively). A rise of serum creatinine was noted during fasting in 60.4% of patients by Day 7 and was associated with intake of renin angiotensin aldosterone system antagonists [relative risk (RR) 2, P = 0.002]. Adverse cardiovascular events were observed in six patients in the fasting cohort and were associated with a rise of serum creatinine after 1 week of fasting (P = 0.009) and the presence of pre-existing cardiovascular disease (RR 15, P = 0.001); the latter association was confirmed by logistic regression analysis. Only one event was recorded in the nonfasting group, P = 0.036.ConclusionsMACE occurred more frequently among fasting CKD patients with pre-existing cardiovascular disease and were predicted by an early rise of serum creatinine.

Effects of Intermittent Fasting, Caloric Restriction, and Ramadan Intermittent Fasting on Cognitive Performance at Rest and During Exercise in Adults

“…Their results suggested that dehydration occurs during daytime fasting and is reversed at sunset but that its effects are difficult to assess because of these daily fluctuations. Despite variations in kidney function, they did not notice any changes in blood pressure, which, however, does not necessarily exclude the possibility of dehydration [127]. Further studies should explore the possible impact of fasting and dehydration on cognitive functioning in greater depth and detail.…”

“…However, few studies have reported on the effect of dehydration due to IF without fluid consumption. One such study by NasrAllah and Osman [127] explored the effect of fasting among 52 patients with chronic kidney disease during RIF. Their results suggested that dehydration occurs during daytime fasting and is reversed at sunset but that its effects are difficult to assess because of these daily fluctuations.…”

Increase in Ischemic Stroke Incident Hospitalizations Among Bedouin Arabs During Ramadan Month

“…Such alterations have the potential to induce cardiovascular events. 7,31,32 However, several studies assessing the incidence of various cardiovascular outcomes failed to demonstrate increased risk during Ramadan. 9,20,33 Similarly, previous studies have failed to demonstrate increased stroke risk during Ramadan, comparing stroke admissions during the Ramadan to the previous month or to other months.…”

“…Several physiological changes such as changes in circadian rhythm,4 serum lipid and glucose levels5 as well as renal function markers and hematocrit levels,6 have been reported among observant Muslims during Ramadan. In addition, Ramadan has been associated with exacerbation of several medical conditions such as diabetes mellitus, migraines, and chronic kidney disease 7. Nevertheless, the effect of Ramadan on cardiovascular morbidity is not clear 8, 9…”

“…In addition, Ramadan has been associated with exacerbation of several medical conditions such as diabetes mellitus, migraines, and chronic kidney disease. 7 Nevertheless, the effect of Ramadan on cardiovascular morbidity is not clear. 8,9 Ischemic stroke is one of the most prevalent causes for hospitalization and mortality in the Western world.…”