Fasting ramadan & kidney disease
•
0 likes•118 views
It discuss the effects of fasting on kidney diseases and what should be our advises to our Muslim patients during the month of RAMADAN
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Fasting ramadan & kidney disease
Similar to Fasting ramadan & kidney disease (20)
Recently uploaded
Recently uploaded (20)
Fasting ramadan & kidney disease
- 1. Ramadan Fasting & kidney disease Yousef BOOBES, MD, CES, FASN Consultant Nephrologist Tawam Hospital, Al Ain - UAE Al Ain February 26,2021 Ramadan Fasting in Patient with Chronic Illness - Workshop
- 2. Outline • Introduction • Medical Aspect • Effect of fasting on kidney diseases • Islamic Aspect • The definition of a disease that permits breaking the fasting • Our advise to our renal patients
- 3. Introduction
- 4. Fasting during Ramadan • It is the forth pillar of Islam and most Muslims are strictly adhering to it • The sick patients are exempted • Most of Muslim with renal diseases is very keen to observe the fast
- 5. Our advise to patients to fast or not to fast is considered a “Fatwa” • To give a correct “Fatwa” you need two elements: • Medical knowledge: Effects of fasting on kidney diseases • Islamic knowledge: The definition of the disease that permits break fasting
- 8. Tawam Study in Transplant Patients
- 9. Methods & Patients • Prospective observational study (Ramadan 1426 à Oct- Nov 2005) • Fasting time was ~ 12.5 h • Inclusion criteria were: • Transplanted for more than one year • Stable kidney function • Voluntary chose to observe the fast • Exclusion criteria were any acute illness Boobes Y, et al. SJ Kid Dis Transpl. 2009;20(2):198–200
- 10. Methods & Patients • 22 kidney transplant recipients completed the study • 10 males and 12 females • Mean age was 47±11.6 (25-69) years • eGFR (MDRD) ml/mim/1.73m2, (Mean±SD) • 16 pts >50 • 6 pts GFR ≤50 • Blood and urine samples were taken just before “Iftar” • Comorbid conditions were • Hypertension: 20 pts • Dyslipidemia: 9 pts • Diabetes mellitus 5 pts Boobes Y, et al. SJ Kid Dis Transpl. 2009;20(2):198–200
- 11. Results - Clinical Parameters Boobes Y, et al. SJ Kid Dis Transpl. 2009;20(2):198–200 0 20 40 60 80 100 120 140 Weight BPs BPd p= NS p= NS p= NS Pre Post During Pre Post During Pre Post During
- 12. 0 1 2 3 4 5 6 7 8 Urea 0 20 40 60 80 100 120 s. Creatinine Post During Pre Post During p = NS p = NS Pre Post During p = NS p = NS Pre Post During Results - Kidney Function Boobes Y, et al. SJ Kid Dis Transpl. 2009;20(2):198–200
- 13. Results - Others PRE Mean ± SD DURING Mean ± SD POST Mean ± SD Pre- Dur p Pre- Post P Uric Acid mmol/l 0.4 ± 0.1 0.38 ± 0.08 0.39 ± 0.08 0.1 0.4 Na mmol/l 139 ± 3.3 137 ± 3.95 138 ± 2.5 0.18 0.37 K mmol/l 4.2 ± 0.4 4.3 ± 0.5 4.2 ± 0.4 0.3 0.8 HCO3 mmol/l 25 ± 2.9 25 ± 3.4 25 ± 3 0.9 0.4 Albumin 36 ± 3.4 36 ± 3.3 37 ± 3.8 0.7 0.02 Hemoglobin 11.9 ± 2.97 12.9 ± 1.5 13 ± 1.9 0.23 0.17 Boobes Y, et al. SJ Kid Dis Transpl. 2009;20(2):198–200
- 14. Results – Others PRE Mean ± SD DURING Mean ± SD POST Mean ± SD Pre- Dur p Pre- Post P T. Choles mmol/l 5.04 ± 1.11 5.1 ± 1.2 5.03 ± 0.83 0.39 0.07 HDL mmol/l 1.03 ± 0.31 1 ± 0.27 1.05 ± 0.25 0.85 0.42 LDL mmol/l 3.3 ± 1.08 3.37 ± 1.02 3.08 ± 0.96 0.07 0.8 TG mmol/l 1.71 ± 0.62 1.34 ± 0.43 1.59 ± 0.44 0.0011 0.7 Boobes Y, et al. SJ Kid Dis Transpl. 2009;20(2):198–200
- 15. Conclusion • It is safe for a kidney recipient to fast Ramadan after one year & they have stable kidney functions • It is in agreement with other studies Boobes Y, et al. SJ Kid Dis Transpl. 2009;20(2):198–200
- 16. Tawam Study During Ramadan 2005 (Oct–Nov)
- 17. Patients & Methods • Prospective observational cohort study • 31 pts • 19 male, 12 female • CKD III 14, CKD IV 12, CKD V five • 19 suffering from diabetes, 22 from HTN • Mean age 54.0±14.2 years Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 18. Results - Clinical • The fasting time (Ramadan 1426 H) was around 12.5 h • All patients managed to fast the whole of the month of Ramadan • Non of them had any undue clinical manifestation Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 19. Clinical Parameters PRE Mean ± SD DURING Mean ± SD POST Mean ± SD P Value Weight kg 76.4 ± 18 75 ± 17.6 75.7 ± 18 0.13 SBP mmHg 138 ± 13.2 133.2 ± 15 131 ± 26.3 o.21 DBP mmHg 81.3 ± 9 78.2 ± 9.3 80 ± 10 0.6 Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 20. Electrolytes PRE Mean ± SD DURING Mean ± SD POST Mean ± SD P Value Na mmol/l 133.8±23 137±3 138±3 NS K mmol/l 4.7±0.6 4.8±0.7 4.8±0.6 NS HCO3 mmol/l 22.5±3.9 24.2±4 23±3.7 NS Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 21. Renal Function PRE Mean ± SD DURING Mean ± SD POST Mean ± SD P Value S. Creatinine µmol/l 245±128 238±109 237±127 0.17 Urea mmol/l 13.4±8 12.6±6 14±7.4 NS Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 22. Renal Function Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 23. DM Control & Hemoglobin PRE Mean ± SD DURING Mean ± SD POST Mean ± SD P Value Glucose mmol/l 8±3 13.4±8 11.2±16 0.27 Hb A1c % 6.8±1.4 6.7±1.8 7.4±2 NS Hb g/dl 12±1.5 12±1.7 12±1.6 NS Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 24. Urinary Protein Excretion PRE Mean ± SD DURING Mean ± SD POST Mean ± SD P Value Proteinuria g/l 1.7±2.3 1.4±1.8 1.6±1.7 NS Prot/creat mg/mg 2±2.6 2±3 2.4±3.1 0.11 Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 25. Conclusion • Fasting Ramadan is safe in patients with CKD (stage III – V) Bernieh B, Al Hakim MR, Boobes Y, Abu Zidan FM. SJ Kid Dis Transpl. 2010;21:898–902
- 26. Bakhit et al. Saudi Med J 2017; Vol. 37 (1): 48-52
- 27. Patients & Methods • 65 patients with CKD stage III-V , mean age of 53 years • Fasted for 15 h/d in Riyadh in the summer of 2015 • Clinical and biochemical data were collected • within the 3 months before Ramadan • after fasting for at least 10 days • 3months after Ramadan. Bakhit et al. Saudi Med J 2017; Vol. 37 (1): 48-52
- 28. Results • 22 pts (33.8%) developed WRF • 15 patients developed WRF during Ramadan • 7 patients in 3 m after Ramadan • 8 later improved, 14 continued (20.5%) • Risk factors: • More advanced CKD stage • Higher baseline systolic BP • Younger age • Improvement in mean systolic BP & HbA1C à post-Ramadan Bakhit et al. Saudi Med J 2017; Vol. 37 (1): 48-52
- 29. Conclusion • Ramadan fasting during the summer months was associated with worsening of renal function Bakhit et al. Saudi Med J 2017; Vol. 37 (1): 48-52
- 30. Results • Mean serum creatinine (SD) • 206 μmol/l (88) before Ramadan • 214 μmol/l (37) during Ramadan • 209 μmol/l (101) 3 months after fasting Bakhit et al. Saudi Med J 2017; Vol. 37 (1): 48-52
- 31. Bragazzi NL. Int J Nephrol Renovasc Dis. 2015 Jun 1; 8:53-57
- 32. eGFR in CKD Patients Before & After Ramadan Bragazzi NL. Int J Nephrol Renovasc Dis. 2015 Jun 1; 8:53-57 p=0.99
- 33. eGFR in CKD Patients Before & After Ramadan Bragazzi NL. Int J Nephrol Renovasc Dis. 2015 Jun 1; 8:53-57 p=0.73
- 34. eGFR in CKD Patients Before & After Ramadan Bragazzi NL. Int J Nephrol Renovasc Dis. 2015 Jun 1; 8:53-57 p=0.66
- 35. Journal of Research in Medical Sciences Bragazzi NL. J Res Med Sci. 2014 Jul;19(7):665-76.
- 37. Ramadan and Urolithiasis • 1,262 pts have been studied • Ramadan fasting does not • deteriorate health condition in subjects with renal colic • does not cause hypercalciuria • does not impair the balance between lithogenic promotors (oxalate, Ca++, uric acid, phos) and inhibitors (citrate, Mg++) Bragazzi NL. J Res Med Sci. 2014 Jul;19(7):665-76.
- 38. Ramadan and chronic kidney disease • Summarizing all the studies: • 140 subjects with CKD have been investigated: • 40 on hemodialysis • 18 on peritoneal dialysis (PD) • 15 on predialysis • 67 on pharmacological treatment Bragazzi NL. J Res Med Sci. 2014 Jul;19(7):665-76.
- 39. Ramadan and chronic kidney disease • Most studies did not find any differences between before and after Ramadan fasting • Bernieh et al. found improvements during the fasting and after • 3 studies presented mixed evidences of an increased risk for fasting patients during Ramadan, and 3 clear negative evidences Bragazzi NL. J Res Med Sci. 2014 Jul;19(7):665-76.
- 40. Ramadan and kidney transplant • 463 pts who received kidney transplant have been investigated • Biochemical parameters do not change significantly • No rejection or deterioration of KF were observed • One author reported of adverse effects due to cyclosporine toxicity, acute rejection episodes, and urinary infections Bragazzi NL. J Res Med Sci. 2014 Jul;19(7):665-76.
- 41. CONCLUSIONS • There are no evidences that Ramadan is injurious for patients with CKD willing to fast, even though further high quality research is welcome. Bragazzi NL. J Res Med Sci. 2014 Jul;19(7):665-76.
- 42. Islamic aspect
- 43. • ﺷ َ ﮭ ْ ر ُ ر َ ﻣ َ ﺿ َ ﺎ ن َ ا ﻟ ﱠ ذ ِ ي أ ُﻧ ز ِ ل َ ﻓ ِ ﯾ ﮫ ِ ا ﻟْ ﻘ ُ ر ْ آ ن ُ ھ ُ د ً ى ﻟ ِّ ﻠ ﻧ ﱠ ﺎ س ِ و َ ﺑ َ ﯾ ِّ ﻧ َ ﺎ ت ٍ ﻣ ِّ ن َ ا ﻟْ ﮭ ُ د َ ى ٰ و َ ا ﻟْ ﻔ ُ ر ْ ﻗ َ ﺎ ن ِ ◌ ۚ ﻓ َ ﻣ َ ن ﺷ َ ﮭ ِ د َ ﻣ ِ ﻧ ﻛ ُ م ُ ا ﻟ ﺷ ﱠ ﮭ ْ ر َ ﻓ َ ﻠْ ﯾ َ ﺻ ُ ﻣ ْ ﮫ ُ ◌ ۖ و َ ﻣ َ ن ﻛ َ ﺎ ن َ ﻣ َ ر ِ ﯾ ﺿ ً ﺎ أ َ و ْ ﻋ َ ﻠ َ ﻰ ٰ ﺳ َ ﻔ َ ر ٍ ﻓ َ ﻌ ِ د ﱠ ة ٌ ﻣ ِّ ن ْ أ َ ﯾ ﱠ ﺎ م ٍ أ ُ ﺧ َ ر َ ◌ ۗ ﯾ ُ ر ِ ﯾ د ُ ا @ ﱠ ُ ﺑ ِ ﻛ ُ م ُ ا ﻟ ْ ﯾ ُ ﺳ ْ ر َ و َ ﻻ َ ﯾ ُ ر ِ ﯾ د ُ ﺑ ِ ﻛ ُ م ُ ا ﻟ ْ ﻌ ُ ﺳ ْ ر َ و َ ﻟِ ﺗ ُ ﻛ ْ ﻣ ِ ﻠ ُ و ا ا ﻟْ ﻌ ِ د ﱠ ة َ و َ ﻟِ ﺗ ُ ﻛ َ ﺑ ِّ ر ُ و ا ا R ﱠ َ ﻋ َ ﻠ َ ﻰ ٰ ﻣ َ ﺎ ھ َ د َا ﻛ ُ م ْ و َ ﻟ َ ﻌ َ ﻠ ﱠ ﻛ ُ م ْ ﺗ َ ﺷ ْ ﻛ ُ ر ُ و ن َ ) 185 ( • But whoever of you is ill or on a journey, then ˹let them fast˺ an equal number of days ˹after Ramaḍân˺. Allah intends for you ease, and He does not want to make things difficult for you (Baqara-185)
- 45. The Fiqh Encyclopedia The definition of a disease that permits breaking the fasting • A disease that increases with fasting • If the pt fears that the disease will increase by fasting, or if it is not harmful but difficult; He may break his fast. It is the doctrine/view of the majority of scholars : Hanafi, Maliki and Hanbali • A disease that harmed by fasting with fears of perishing • If the disease harms the fasting person, and he fears death because of it; Break fast is obligatory • This is the doctrine of the majority: Hanafi, Maliki, and Shafi’i, and a group of Hanbali • A mild disease • A disease in which fasting does not affect, or it is not harmful - such as easy headache or a toothache – • it is not permissible to break his fast, and this is according to the agreement of the four fiqh schools
- 46. Our advise to our patient
- 47. In general, Fasting Ramadan is good for health • Fasting Ramadan has many Social, Psychological & Physical Health Benefits • May promote insulin sensitivity: … • May promote healthy guts: which in turn aids immune and digestive processes • Can help lower of blood sugar & cholesterol • Increasing boost of will power.
- 48. In general, Fasting Ramadan is good for health • (ex.) A study at the University of Texas conducted on the effects of intermittent fasting, found that it • reduces inflammation • improves blood lipids • helps in weight loss • Participants did not reduce their total calories – just the time frame in which they consumed them Tinsley GM, et al. Effects of intermittent fasting on body composition. Nutr Rev. 2015 Oct;73(10):661-74.
- 49. In general, Fasting Ramadan is good for health • Fasting Ramadan has many Social, Psychological & Physical Health Benefits • Increasing boost of will power. • A Study demonstrated that fasting Ramadan have been effective in diminishing stress, anxiety, and depression levels (statistically significant) • .. Koushali AN, et al. Iran J Nurs Midwifery Res. 2013;18(3):232-236.
- 50. ﯾ ُ ر ِ ﯾ د ُ ا 3 ﱠ ُ ﺑ ِ ﻛ ُ م ُ ا ﻟ ﯾ ُ ﺳ ر َ و ﻻ َ ﯾ ُ ر ِ ﯾ د ُ ﺑ ِ ﻛ ُ م ا ﻟ ﻌ ُ ﺳ ر َ • (Allah intends for you ease, and He does not want to make things difficult for you) • Islam is a religion of ease, and ease is a supreme goal of of Sharia
- 51. Doctor Will Give the Advice “Fatwa” to Patient • The ruling on fasting of Ramadan for Kidney disease patients varies from obligation to allowable to forbidden, depending on the severity of the disease and the effect of fasting
- 52. Rule of Fasting • Stable vs unstable or acutely ill • All studies looked on the effect of fasting in stable patients
- 53. Rule of Fasting • CKD stage I and stage II • They fast Ramadan as healthy • CKD stage III • CKD IIIa: They could not fast but fasting would be better • CKD IIIb: They could not fast and this would be better • CKD stage IV and stage V (pre dialysis) • They could not fast (preferable & we encourage them to not fast) • if they choose to fast – it should be done under medical supervision • If they develop significant worsening of kidney function (>25%) due to fasting à become forbidden
- 54. Rule of Fasting • ESRD on Hemodialysis • Dialysis days: It is allowable to not fast (highly recommended) if HD done during the day • They will be very weak • HD breaks fasting (in one fatwa), and it does not (in other one) • Some ask to switch to night shift • Other days: It is allowable to not fast
- 55. Rule of Fasting • Transplant patients (CKD TII-TIII): • It is allowable to not fast. • Fasting during the 1st 6 months post op strongly discouraged and could be forbidden • If they missed Sahoor’s IS doses, they should break fast and take these medications
- 56. If kidney disease patient choose to fast à he should do it under close observation à General Recommendations
- 57. General Recommendations • CKD stage I to V • They should drink enough fluids during the night with much diet control • They are not working outdoor (under the sun) • Check s. creatinine before fasting and 7 days after the beginning of the fast, especially If eGFR <20. • If stayed stable, they can continue their fast; • otherwise they should break their fast
- 58. General Recommendations • Transplant patients: • They could attempt fasting providing that they drink enough fluids during the night with much diet control • They are not working outdoor (under the sun) • Cyc/Tac trough level should be checked before they break fast • It is advisable to check s. creatinine before fasting and within 7 days after the beginning of the fast. If it is not stable, pt should break their fast. • Consider switching pt from Prograf to Advagraf before Ramadan • Fasting Ramadan during summer in some northern countries might be impossible -à forbidden
- 59. ﯾ ُ ر ِ ﯾ د ُ ا 3 ﱠ ُ ﺑ ِ ﻛ ُ م ُ ا ﻟ ﯾ ُ ﺳ ر َ و ﻻ َ ﯾ ُ ر ِ ﯾ د ُ ﺑ ِ ﻛ ُ م ا ﻟ ﻌ ُ ﺳ ر َ • (Allah intends for you ease, and He does not want to make things difficult for you) • Islam is a religion of ease, and ease is a supreme goal of of Sharia
- 60. Thank You