Exclusive: How Kidney Patients Can Fast During Ramadan Without Compromising Their Health

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The month of Ramadan is a sacred time for Muslims. It is a time when Muslims around the world observe a strict fast from sunrise to sunset with a prohibition of both food and water. The meal before dawn is referred to as suhoor, whereas the meal after sunset is known as iftar.

In an interview with Boldsky, Dr Garima Aggarwal, Consultant Nephrologist and kidney transplant specialist, Manipal Hospitals, shres how one can observe Ramadan fasts while managing kidney disease by careful consideration and planning.

Here are some doctor approved general precautions and tips for kidney patients during Ramadan.

Ramadan has started, so consult with your doctor before fasting. They will adjust your medication timings and dosages to fit the fasting schedules without compromising your health. Taking medicines like diuretics, some diabetic medicines, and some blood pressure medicines while you are fasting might cause complications and hence your doctor may withhold those.

Monitoring And Testing During The Month Of Ramadan

1. Patients with chronic kidney disease (CKD) should monitor their weight and blood pressure daily.
2. Diabetic patients with kidney disease should regularly monitor their blood sugars. They are at a high risk of having dangerously low blood sugars (called hypoglycemia) due to fasting and kidney disease.
3. Patients with advanced CKD should monitor their creatinine and electrolytes (sodium and potassium) at least once a week during fasting (or as per their doctor's advice)

Fasting Should Be Broken If

• If serum creatinine increased by ≥ 30% from the previous baseline value.
• In case of an increase or decrease in electrolyte tests like sodium or potassium
• In case of any episodes of very low blood sugar or hypoglycaemia, blood sugar level of less than 70 mg/dl

General Precautions That You Must Take During Fasting Days

- Liquid intake - Drink fluids as per the doctor's advice during non-fasting hours to prevent dehydration. Your doctor may increase your fluid intake during fasting days.

- Diet- Consume a balanced diet during Suhoor (pre-dawn meal) and Iftar (meal to break the fast) that includes the right balance of carbohydrates, proteins, and fats. Limit high-sodium foods containing too much salt, avoid high-potassium foods like juices, certain fruits, and green leafy vegetables, and high phosphorus foods like dairy products, seeds, and meats if you suffer from CKD.

- Timing of medicines - Discuss with your nephrologist about adjusting the timing of all your medications to twice a day during suhoor and iftar. If you need to take medications more than twice a day - you should not fast.

- Dialysis schedule - If you are on hemo or peritoneal dialysis, it is best to avoid fasting. After discussion with your doctor if you decide to fast you'll need to coordinate your treatment sessions around your non fasting hours.

Patients are prone to low blood sugar and low blood pressure episodes during dialysis and will need to take emergency food or medications for the same. Your nephrologist can help schedule your sessions and adjust your fluid intake. Fasting may be planned during non-dialysis days only.

- Physical activity - Reduce physical activity during fasting hours to prevent dehydration and conserve energy.

- Kidney Transplant - Patients who have had a kidney Transplant and are in stable condition can safely fast during Ramadan but they must first consult their nephrologist to take approval and adjust the timing of medicines as needed.

- Kidney stones -Patients with kidney stones must ensure adequate hydration during non-fasting hours and avoid foods that are high in oxalates and salt.

Alarming symptoms
Patients must watch out for these symptoms which may indicate worsening kidney health and may necessitate them breaking their fast such as
· an increase in weight (>2 kg from the baseline),
· breathing difficulty,
· loss of weight and appetite,
· swelling of both feet or body,
· extreme fatigue,
· dizziness,
· confusion,
· and difficulty in urinating, or low volume of urine.

Which Patients Should Avoid Prolonged Fasting?

Patients suffering from recent or current acute kidney disease, people with very high blood sugars or poorly controlled diabetes, those diabetics who are on multiple doses of insulin throughout the day, or people with very high blood pressure, active heart disease, or repeated chest pains, active or recent infections, diseases such as heart disorders or liver diseases leading to being bedridden, or those patients who have trouble in sticking to dietary restrictions and/or don't take their medicines on time - should avoid fasting during the month of Ramadan.

Older patients who are frail or pregnant women, especially those who have high blood sugar, blood pressure or kidney abnormalities during pregnancy should also avoid fasting.

It's important to remember that Islamic teachings provide exemptions from fasting for those whose health may be adversely affected. The priority should always be your health and well-being.

Ramadan Kareem!

Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.