The Effects of Intermittent Fasting during the Month of Ramadan in Chronic Haemodialysis Patients in a Tropical Climate Country

Abstract

BackgroundChronic kidney disease is an emerging problem in the majority Muslim countries. Despite the uncertainties of the risks involved, some Muslim patients undergoing chronic haemodialysis choose to observe intermittent fasting during the month of Ramadan. This study aims to investigate the effect of Ramadan fasting in haemodialysis patients residing in a tropical climate country.MethodsThis prospective cross sectional study recruited Muslim patients on regular haemodialysis from three haemodialysis centres in Kuala Lumpur from 15th July 2011 to 29th August 2011. Patients who fasted for any number of days were included (n = 35, 54% female, age 54±11 years). 89% of patients fasted for more than 15 days and 49% were diabetics. Dialysis parameters and blood samples were obtained one week prior to Ramadan and during the last week of Ramadan. The differences in dialysis parameters and biochemical values pre- and end-Ramadan were examined using paired t-test.ResultsBoth pre- and post-dialysis weight were significantly decreased during Ramadan fasting compared to the month prior (p = <0.001). There was a significant decrease in the amount of ultrafiltration (p = 0.002). There were no significant differences in dry weight, inter-dialytic weight gain, mean urea reduction ratio or blood pressure measurements comparing pre- and end of Ramadan fasting. There was a significant increase in serum albumin level (p = 0.006) and decrease in serum phosphate level (p = 0.02) at the end of Ramadan.ConclusionRamadan fasting is associated with reduced weight, improved serum albumin and phosphate level in our population of haemodialysis patients. A larger multi-centre study will allow us to understand more about the effects of fasting in this population.

The effects of Ramadan fasting on clinical and biochemical markers among hemodialysis patients: A prospective cohort study

“…One study reported that Ramadan fasting was associated with increase in mean IDWG by 0.6 kg among Saudi hemodialysis patients [20]. Other studies reported that Ramadan fasting was associated with either decrease or no significant difference in IDWG [3, 22, 24, 25]. The underlying mechanisms for our observation of increasing mean IDWG in RFG and RPFG is not clear, as our study did not collect dietary information.…”

“…Some studies have reported that Ramadan fasting was associated with significant changes in clinical and biomedical markers, such as fluid overload and hyperkalemia, but with no significant complications requiring hospitalization [3, 20]. Other studies found no clinically important variations in biomedical markers in hemodialysis patients during Ramadan fasting [21, 22]. Due to the lack of clear evidence about the safety of Ramadan fasting by CDK and hemodialysis patients, the International Diabetes Federation and Ramadan International Alliance consider these patients to be at very high risk, and are, therefore, exempted from Ramadan fasting.…”

Lipids, Lipoprotein Distribution and Nutritional Parameters over the Ramadan Period in Hemodialysis Patients

“…In HD subjects with dyslipidemia (high plasma triacylglycerol (TAG) and low high-density lipoprotein cholesterol (HDL-C) concentrations), changes in dietary habits (as in the case during R), regardless of whether subjects opt to fast the entire stretch or fast for only a portion of the R period, may affect circulating lipoproteins. There is however limited information available on alterations in plasma lipids [30] during the period of R in HD patients. Wan Md Adnan et al [30] noted decreased low-density lipoprotein cholesterol (LDL-C) concentrations at the end of R in diabetic HD patients, while Adanan et al [29] reported no effects on LDL-C. Mixed results have also been obtained in healthy individuals where increased LDL-C and lower TAG [15], or no effects on LDL-C [31] or decreased LDL-C [29,32] have been observed during the R period.…”

“…There is however limited information available on alterations in plasma lipids [30] during the period of R in HD patients. Wan Md Adnan et al [30] noted decreased low-density lipoprotein cholesterol (LDL-C) concentrations at the end of R in diabetic HD patients, while Adanan et al [29] reported no effects on LDL-C. Mixed results have also been obtained in healthy individuals where increased LDL-C and lower TAG [15], or no effects on LDL-C [31] or decreased LDL-C [29,32] have been observed during the R period. In contrast, a meta-analysis in healthy subjects during R found a significant reduction in LDL in both genders, a significant reduction in total cholesterol and TAG amongst males and a significant increase in HDL-C among females [16].…”

Behavioral gastroenterology: An emerging system and new frontier of action

“…Intermittent fasting generally entails normal intake for 5 d a week, but intake of a quarter of the normal calories for the other 2 d (usually 500 calories for females, 600 calories for males). A multicenter and large sample research demonstrated that patient body weight was reduced by 4.3 kg on average after 6 wk of intermittent fasting[ 30 ]. Halberg et al[ 31 ] found that healthy people who underwent 2 wk of intermittent fasting exhibited no obvious body weight loss, but they did show improved insulin sensitivity - that is, the capacity for glucose storage and fat decomposition was increased.…”