Fasting is a common practice for various reasons, including religious, spiritual, and health-related purposes. In many cultures, particularly in the United Arab Emirates, fasting during Ramadan carries great significance as it is a time for spiritual reflection, strengthening social bonds, and deepening one’s connection with God. While fasting is obligatory for every sane adult Muslim, Islamic law exempts patients if fasting could harm them or worsen their medical condition.
For patients with chronic kidney disease (CKD), especially those undergoing dialysis, fasting poses unique challenges that require careful management of meals and nutrient balance. Despite these difficulties, many dialysis patients wish to fast during Ramadan to share in the spiritual and social atmosphere of the holy month. However, fasting can affect hydration levels, electrolyte balance, and the clearance of waste products—functions normally performed by the kidneys.
This article aims to explore the effects of fasting on dialysis patients, provide strategies for meal adjustments, and offer health management tips during fasting periods in line with the spirit of Ramadan.
Understanding Dialysis and Its Role
Dialysis is a medical treatment that replicates the kidney’s function of filtering waste and excess fluids from the blood. There are two main types:
- Hemodialysis: blood is filtered outside the body through a special machine.
- Peritoneal dialysis: a special fluid absorbs waste products through the abdominal lining.
Patients often require dialysis when kidney function deteriorates due to conditions such as diabetes, high blood pressure, or kidney infections. These patients must follow strict dietary guidelines to maintain fluid and electrolyte balance, making fasting more complicated for them.
Effects of Fasting on Dialysis Patients
1. Fluid Imbalance
Fasting may lead to dehydration due to prolonged hours without water, which can cause dizziness, low blood pressure, or even serious complications. Since the kidneys cannot remove excess fluid, maintaining fluid balance becomes a greater challenge during fasting.
2. Electrolyte Disturbances
Dialysis patients must carefully monitor potassium, sodium, and phosphorus levels. During Ramadan, some may eat dates or bananas at iftar or suhoor, which increases the risk of hyperkalemia (high potassium), potentially leading to serious heart problems.
3. Nutrient Deficiency
Dialysis patients need more protein than healthy individuals to compensate for losses during dialysis sessions. Fasting may make it harder to get enough protein and essential nutrients such as calcium, vitamin D, and iron, increasing the risk of malnutrition, anemia, and bone weakness.
4. Metabolic Effects
Prolonged fasting may cause the body to break down muscle for energy and increase the buildup of toxins like urea and creatinine. Blood sugar levels may also drop or rise, especially in diabetic patients.
Tips for Adjusting Meals and Managing Health During Fasting
- Consult healthcare providers: Patients should consult their nephrologist and dietitian before fasting to develop a suitable nutrition plan.
- Focus on balanced, nutrient-rich meals: Prioritize high-quality protein (lean meat, fish, eggs) with vegetables and grains in moderation, while limiting high-potassium and high-phosphorus foods.
- Hydration strategies: Drink moderate amounts of water distributed between iftar and suhoor to avoid dehydration.
- Monitor blood sugar and blood pressure: Especially for diabetic patients or those taking medications that affect sugar and pressure levels.
- Use supplements if needed: Vitamin D, calcium, iron, or protein supplements may be recommended under medical supervision.
- Listen to your body: If symptoms like extreme fatigue or dizziness occur, patients should consult their doctor and may need to break their fast to protect their health.
Conclusion
Fasting is a challenge for dialysis patients, as it may cause dehydration, electrolyte imbalances, nutrient deficiencies, and metabolic disturbances. However, with proper planning, medical guidance, and a balanced diet, some patients may be able to fast safely. The priority should always be protecting health, in line with Islamic teachings that permit exemptions from fasting in cases of harm.
References
- National Kidney Foundation (NKF): www.kidney.org
- American Kidney Fund (AKF): www.kidneyfund.org
- Clinical Journal of the American Society of Nephrology (CJASN): https://cjasn.asnjournals.org/
- Dietary guidelines for kidney disease and dialysis – academic references
- Journal of Renal Nutrition: Elsevier link
- International Society of Renal Nutrition and Metabolism (ISRNM): www.renalnutrition.org
- World Health Organization (WHO): www.who.int
This article was written by Dietitian Hafsa Jamil Saleh
