Patients with kidney disease are advised to take precautions if they choose to fast during the holy month of Ramadan, Dr Hassan Al Malki, Nephrology and Transplant Senior Consultant at Hamad Medical Corporation (HMC), has advised.

Chronic kidney disease (CKD), a long-term condition involving the gradual loss of kidney function, can be categorised into five stages based on severity. CKD affects about 13% of Qatar’s population. Dr Al Malki cautioned:

The category of severity of a patient’s kidney disease can indicate if he or she will be able to fast safely. For instance, patients with acute kidney failure should not fast until they fully recover. However, CKD patients have different stages of nephropathy (kidney disease), and patients diagnosed with stage three CKD or higher are advised not to fast as their kidneys fail to retain normal rates of body fluids, making them susceptible to further renal dysfunction and renal damage.’

He stressed that abstaining from food and water for long hours can lead to dehydration. CKD patients should consult their physician to assess the severity of their condition and the potential risks associated with fasting. Dr Al Malki added:

Hemodialysis (a type of renal replacement therapy) patients typically undergo dialysis three times per week and cannot fast due to IV fluid intake during the procedure; however, these patients can fast during the rest of the week.’

He also advised that kidney transplant patients should refrain from fasting due to their need to comply with their prescribed medication dosages and times. As many kidney transplant patients are diabetic, fasting may have a negative impact on their health. Therefore, it is imperative that these patients consult their physician before they decide to fast.

HMC Dietitian, Ayman Alawneh, emphasized that patients with kidney disease must consult their dietitian in order to ensure adequate protection against potential complications while fasting. He mentioned that many kidney disease patients tend to overlook the importance of maintaining a healthy and balanced diet while fasting. He highlighted:

Kidney disease patients should not skip Suhoor (pre-dawn meal) to avoid body weakness, bearing in mind that they need more calories than individuals in good health. Kidney disease patients should be on guard not to ingest high quantities of sodium, potassium and phosphorus, especially during Ramadan. Sodium is abundantly contained in table salt, as is potassium in some vegetables such as tomatoes, potatoes, okra and green leafy veggies as well as some fruits, including bananas, oranges, mangos, dates, apricots, peaches and cantaloupe. Phosphorus is found in beans, carbonated drinks, nuts and dairy products.’

Alawneh stressed that patients who are on phosphorus lowering medications should take their pills during meals, not before or after eating. According to him, each kidney disease has its own dietary requirement for Ramadan. He said:

If physicians approve fasting for pre-dialysis kidney patients, they should maintain a diet low in protein-rich foods to avoid imposing extra burden on their kidneys that could lead to complete renal failure and increase urea in their system. On the contrary, dialysis patients need to increase their protein intake, especially animal proteins, in order to compensate for the protein lost during the dialysis process. Pre-dialysis kidney patients should drink two to three liters of fluid per day if the volume of urine they pass is within the normal rate, otherwise they should reduce their fluid intake to avoid water retention that could affect the heart and lungs. Hemodialysis patients should be careful not to drink more than one liter of water/fluid daily after Iftar to prevent water retention that would otherwise affect their heart and lungs. Peritoneal dialysis patients can drink up to two liters of water daily, depending on the amount of fluid discarded in the dialysis process. They should be aware of the quantities of fluid they consume and reduce their intake of sweets and fatty foods as they are more prone to cardiovascular diseases.’

He further advised kidney disease patients to avoid spending significant time outside in high temperatures when they are fasting, adding they should also avoid eating salty foods.

Meanwhile, HMC is urging patients with kidney disease who experience any difficulties while fasting to seek urgent professional advice or dial 999 for the Ambulance Service.