Patients with kidney disease should take precaution 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), which can be categorized into five stages based on severity, affects about 13% of the country’s population.

The category of a patient’s kidney disease severity can indicate if he/she will be able to fast or not. 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.’

Dr. Al Malki stressed that since abstention (fasting) 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.

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 days.’

He also advised that kidney transplant patients not fast as they must 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 they consult their physician before they decide to fast.

Ayman Alawneh, HMC Dietitian, said kidney disease patients should consult their dietitian in order to ensure adequate protection against potential complications of fasting, mentioning that many kidney patients tend to overlook maintaining a healthy and balanced diet while fasting.

Kidney disease patients should not skip Sahoor (pre-dawn meal) to avoid weakness of the body, bearing in mind that they need more calories than individuals in good health. Patients should be on their guard not to ingest high quantities of sodium, potassium and phosphorus, especially during Ramadan. Sodium is abundantly contained in table salt, and potassium in some vegetables such as tomatoes, potatoes, okra, and green leafy veggies as well as fruits including bananas, oranges, mangoes, 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 Alwaneh, each kidney disease has its own dietary requirement for Ramadan.

If physicians approve fasting for pre-dialysis kidney patients, they should maintain a diet low in protein-rich food 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 proteins lost in the dialysis process.’

Pre-dialysis kidney patients should drink 2-3 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 2 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 high temperatures when they are fasting and to avoid 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.