Impact of Ramadan Fasting on Nutrition, Inflammation and Dialysis Adequacy among Hemodialysis Patients

Abstract

<title>Abstract</title> <bold>Background</bold> Fasting the holy month of Ramadan is one of the obligatory rituals in Islam. Although sick people are exempted, some insist on fasting. Several studies concerning safety and its impact on patients with different diseases have been reported. In this context, the hemodialysis population represents a special entity. The present study aimed to assess the impact of fasting on nutritional status, inflammatory status, and the adequacy of hemodialysis. <bold>Methods</bold> In this prospective cohort study, 65 hemodialysis patients were recruited from the hemodialysis unit in the Urology and Nephrology Center at Mansoura University, Egypt. The participants were divided into three groups based on different intentions to fast during Ramadan. Group 1 included 21 patients who fasted daily (DFG). Group 2 included 25 patients who fasted non-hemodialysis hemodialysis days; we referred to this group as the partial fasting group (PFG). Group 3 included 19 patients who did not fast; these patients composed the nonfasting group (NFG). Nutritional status was assessed using a subjective global assessment (SGA) and triceps skin fold thickness. The neutrophil to lymphocyte ratio (NLR), human B-cell lymphoma/leukemia2 (BCL2), and advanced glycation end products (sRAGE) were used as inflammatory markers. Hemodialysis adequacy was evaluated by KT/V and the urea reduction ratio (URR). All patient assessments were carried out before, immediately after, and 3 months after Ramadan. <bold>Results</bold> There was a significant reduction in nutritional status in all studied groups (all P &lt;0.05), despite a significant reduction in serum cholesterol and fasting blood sugar levels. The urea reduction ratio (URR) and intradialytic weight gain (IDWG) were the same before and after fasting Ramadan. Kt/V and human soluble receptor for advanced glycation end products (sRAGE) In the <bold>RPFG,</bold> fasting led to significant reductions (all <italic>P</italic> &lt; .02) only in the serum albumin concentration and triceps skin fold thickness. There were no significant changes in BMI, URR, cholesterol, FBS, KT/V, IDWG, SGA score, NLR, and BCL2 or sRAGE. In the <bold>RNFG</bold>, there was a significant reduction (all P&lt;0.02) in triceps skin fold thickness, and a significant change in the SGA score, and in the sRAGE. and BCL2 levels. <bold>Conclusion</bold> There was no harmful effect for Muslim patients receiving regular HD who wanted to fast with Ramadan on days other than HD session days. In the present study, this particular group benefited from both fasting and insignificant changes in almost all nutritional assessment points, inflammatory markers, and the adequacy of HD. Therefore, our findings suggest that partial Ramadan fasting is tolerable by hemodialysis. patients and is not associated with important clinical complications. They should be closely monitored and instructed to adhere to their dietary and fluid intake allowances.