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Fasting during the month of Ramadan constitutes an annual Islamic religious practice, necessitating abstinence from food and drink from dawn to sunset. Ramadan Fasting (RF) is an obligatory practice after puberty and some individuals are exempted including sick people, children, elderly, pregnant and menstruating women. Diabetes and Ramadan International Alliance has major impact on enhancing researches in field of diabetes and RF over many years. Limited studies have examined the effect of RF in various kidney diseases. We describe RF and kidney disease initiative.
RaK initiative was first established on May 2022. A working group of RaK initiative included international panel of experts in field comprising nephrologists, endocrinologists and family medicine physicians located in different countries. RaK members conducted virtual meetings and literature review focusing on the impact of RF in patients with various kidney diseases including acute kidney injury AKI, chronic kidney disease CKD, hemodialysis, kidney transplantation, kidney stones, proteinuria and other risk factors like cardiovascular diseases.
All published studies on RF and the kidney are non-interventional prospective observational studies, and some were retrospective studies. Few studies focused on RF in patients with AKI, CKD and on dialysis (hemodialysis, peritoneal dialysis). In general, small cohort studies showed RF is safe in kidney transplant recipients who had stable kidney function. There are no studies addressing the risk of RF during pregnancy in CKD patients, frailty in elderly CKD patients, prolonged fasting hours > 16 hours and impact of cardiovascular and hepatic diseases on kidney outcomes during fasting, as well as the effect of using specific medications (SGLT2 inhibitors, Tolvaptan, etc..) by CKD patients while they are fasting.
RaK working group agreed on developing the initial risk classification and assessment tool for Ramadan fasting addressing various kidney diseases. The three major elements of this tool focused on risk classification for kidney disease, estimating the risk of Ramadan fasting and recommendations for those who decide fasting during Ramadan. The classification of kidney diseases to mild, moderate and high risks is based on current available evidence and expert consensus. The risk for Ramadan fasting vary from low (safe), moderate and high risk (probably unsafe). It is important to assess patient with kidney disease prior, during and after fasting Ramadan.
RaK initiative will continue to provide fasting recommendations and risk classifications for kidney diseases. It is fundamental to conduct international multicenter studies to prospectively examine the impact of various risk factors related to RF in kidney diseases.