Posted on June 11, 2016

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 categorized into five stages based on severity. CKD affects about 13 percent of Qatar’s population.

“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 body fluid levels, making them susceptible to further renal dysfunction and renal damage,” Dr. Al Malki cautioned.

He stressed that abstaining from food and water for long periods can lead to dehydration. CKD patients should consult their physician to assess the severity of their condition and any potential risks associated with fasting. “Hemodialysis (a type of renal replacement therapy) patients typically undergo dialysis three times per week and cannot fast during this time due to the IV fluid intake which takes place during the procedure; however, these patients can fast the rest of the week,” Dr. Al Malki added.

He also advised kidney transplant patients to refrain from fasting 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 deciding to fast. Mr. Ayman Alawneh, HMC Dietitian, emphasized that patients with kidney disease must consult their dietitian 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.

“Patients suffering from kidney disease should not skip Suhoor (the pre-dawn meal) to avoid feeling weak, bearing in mind that they need more calories than individuals in good health. Kidney disease patients should be careful not to ingest high quantities of sodium, potassium and phosphorus, especially during Ramadan. Sodium is abundant 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,” he highlighted.

Mr. 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 requirements for Ramadan. “If physicians approve fasting for pre-dialysis kidney patients, they should maintain a diet low in protein-rich foods to avoid imposing an extra burden on their kidneys. This could lead to complete renal failure and increase the level of urea in their system,” he advised. “On the other hand, dialysis patients need to increase their level of 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 normal levels, otherwise they should reduce their fluid intake to avoid water retention that could affect the heart and lungs,” he advised. “Hemodialysis patients should be careful not to drink more than one liter of water/fluid daily after Iftar to prevent water retention that could 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,” said Mr. Alawneh.

“Kidney disease patients 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 noted. He further advised them to avoid spending a significant amount of time outside in high temperatures when they are fasting, adding that 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.

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