Can patients with chronic kidney disease fast ?

For Muslims all over the world, the holy month of Ramadan is the most anticipated. Every Muslim is obliged to abstain from all desires, including not eating and drinking, for those who are deemed capable of doing so.

Patients who generally should not fast, i.e. those suffering from acute kidney disease, uncontrolled hypertension, swelling throughout the body, excessive moisture, severe metabolic disorders, rapidly progressive chronic renal disease in stage 3, chronic kidney diseases due to diabetes (eLFG <45), recurrent kidney stones, chronic disease of the kidney in stage 4 or higher, dialysis ( HD dan CAPD). Claw kidneys don't work, polypharmacy.
And then, what about the chronic kidney disease, is it possible to fast? Chronic Kidney Disease Risk category for fasting 3 categories, namely: 1.Low risk - ongoing (chronic kidney disease Stage 1-3 with stable kidney function) 2.High risk (Chronic Kidney disease Stadium 1-3 with unstable renal function, abnormal electrolytes, risk of dehydration) 3.Very high risk (Cronic kidney diseases Stage 4-5, depending on residual kidney functions factors, fluid balance, potassium levels, patients HD and CAPD, chronic kidneys disease stage 3-5 and history of coronary disease, patients with pregnant chronic renal disease) For those at high risk and very high risk there is exploration of alternative options, i.e. short-day fasting (in winter) or paying a ransom.
Patients with HD and CAPD can still fast by considering several factors: 1.Rest renal function (still there is urine) 2.Liquid balance 3.Calium level 4.Motivation and Compliance Drinking Medicine

CAPD patients who intend to fast, there are steps to be taken 1. Consultation with a Disease Specialist Within 1 month before fasting to be assessed: clinical patients (excess fluids, malnutrition), laboratory (potassium, albumin), changes in fluid exchange schedule, medication schedule, nutritional needs. 2.Requirements to patients: fluid intake, Eating low potassium foods, Avoid constipation, monitor blood pressure and Weight

Clinical recommendations for patients who wish to fast: 1. Fasting should be cancelled, if plasma creatinine increases 30% above the baseline and or if there are clinical symptoms due to changes in serum potassium and sodium levels 2. Patients should be monitored during Ramadan and should recognize some alarm symptoms such as weight gain (>2 kg from the start), swelling, shortness of breath, dizziness, anorexia, fatigue, weakness or weakening 3.Body weight, blood pressure, biochemical parameters such as electrolytes (Sodium and Potassium) should be checked regularly throughout Ramadan.

For Friends Hermina who still want to need more information about Chronic Kidney Disease and so on, can directly consult with the Doctor Specialist Internal Diseases at the Hospital Hermina Samarinda.

 

Reviewed : Dr. Astried, Sp.PD, KGH, Finasim

Reference

NCBI. Accessed in 2021. Effects of Ramadan fasting on moderate to severe chronic kidney disease.
Decision of the Ministry of Health of RI 2023. National Guidelines for Chronic Kidney Implementation of Medical Services