Fasting during Ramadan is a deeply spiritual practice for many, but if you are living with Chronic Kidney Disease (CKD) Stage 3 or 4, you may have concerns about managing your health while still observing this religious tradition.
The desire to fast is strong, yet the potential risks to kidney function, hydration, and overall well-being can create uncertainty. The good news is that it may be possible to fast safely with the right precautions. By making adjustments with the help of your healthcare team, following recommendations to minimise risk and exploring alternative ways to observe Ramadan, you can protect your health.
In this blog post, we’ll explore the potential risks of fasting with CKD, how to minimise these risks, and what important conversations to have with your healthcare provider. We’ll also highlight alternative practices that can help you honour Ramadan while keeping your kidneys in mind.
What is Ramadan?
Ramadan, which falls in the ninth month of the Islamic lunar calendar, is considered one of the holiest months for Muslims and a time of fasting, prayer, reflection, and community. It is seen as a way to develop self-discipline, empathy for the less fortunate, and a closer connection to God (Allah). The fasting period is from dawn to sunset and Muslims abstain from all food, drink, smoking, and sinful behavior.
Fasting during Ramadan is one of the Five Pillars of Islam, the fundamental practices that define a Muslim’s faith and actions. However as the fast is meant to be an act of worship that should not harm one’s health or well-being, certain individuals are exempt from fasting including children, the elderly and individuals who are temporarily ill or who have a chronic illness which includes CKD, diabetes, high blood pressure and cardiovascular disease.
Fasting is an individual’s choice, but it is recommended that the decision is made with the support of your imam and collaboration with your healthcare provider. If someone is unable to fast for an extended period, there are alternate ways to fulfil the spirit of Ramadan such as making up the fasts at a later date and/or shorter days, fasting for shorter periods or offering fidyah, which involves providing food or charity to those in need. The goal is to ensure that no one endures harm to their health.
Should I Fast During Ramadan with CKD?
There are many benefits to fasting during Ramadan including a personal sense of fulfilment, improvements in self-control, a greater sense of empathy and community and various spiritual benefits. However, when you have CKD, you will likely ask yourself where you should fast during Ramadan due to your health condition.
The answer to this question is: it depends.
There have been several research studies looking at the potential health risks of fasting during Ramadan and the levels of risks are outlined in the table below.
There is a moderate to high risk of fasting if you have CKD Stages 3 and 4 (with risk increasing with the more advanced your kidney condition is), and therefore understanding your risk in collaboration with your imam and healthcare team is essential. Furthermore, if you do choose to fast, identifying the best strategies to minimise the risks is strongly recommended.
Risk levels for fasting during Ramadan with CKD
| Risk Level | Who? | Is Fasting Safe? | Recommendations |
| High Risk | – CKD Stage 4-5 – Kidney transplant less than 12 months – Acute kidney injury – An ongoing acute illness – Frail – Have had a poor previous fasting experience – Uncontrolled high blood pressure – Poorly controlled type 1 diabetes – History of cardiovascular disease – Pregnancy | Likely to be unsafe; should not fast | Talk to your imam about alternative ways to observe Ramadan e.g. fidyah. |
| MediumRisk | – CKD Stage 3 – Kidney transplant more than 12 months old – Kidney stones (or at risk of kidney stones) – Well-controlled type 1 diabetes – Poorly controlled type 2 diabetes | Safety uncertain; listen to medical advice | Discuss with your imam and healthcare team. If you choose to fast, more frequent monitoring & adjustment of medication may be required. Additional follow recommendations to minimise health risks. May need to consider alternative ways to observe Ramadan e.g. fasting on shorter days and/or at a later date, fasting for a shorter period (alternate days or during the last 10 most religious days of Ramadan), fidyah. |
| Low Risk | – CKD Stage 1-2 – Well-controlled type 2 diabetes | Likely to be safe; listen to medical advice | You can likely observe fasting during Ramadan safely but it is always recommended to discuss with your imam and healthcare team. |
If you would like to know more about how to manage Ramadan or celebrations and social occasions, why not book a FREE 15 minute enquiry call to chat with a kidney specialist dietitian to see how 1:1 support can help you.
Potential physical and mental risks of fasting during Ramadan
If you have CKD, it’s important to consider the potential challenges and risks of fasting for prolonged hours to help you make an informed decision about whether it is the right decision for you. This can help you make an informed choice that supports both your health and your spiritual needs.
1. Dehydration
The risk of dehydration can vary from person to person, depending on your CKD stage, any other health conditions you may have, the length of your fast, and even the season or temperature at the time of fasting. Dehydration can affect your kidney function and blood pressure, so it’s something to be mindful of.
Kidney transplant:
If you’ve had a kidney transplant, especially in the early stages, you may be advised to drink a lot of fluids—often between 3 and 6 litres per day. Since fasting during the day means you’re unable to drink, it could be harder to meet this fluid intake, and dehydration could pose risks to your transplanted kidney. However, if your transplant is stable and you’re passing normal amounts of urine, you might not be as affected by this risk.
CKD:
If you have CKD, dehydration could lead to a sudden decrease in kidney function, known as acute kidney injury. This can happen more easily if you’re in the later stages of CKD (Stages 3-5). It’s something to keep in mind when fasting.
At risk of kidney stones:
Dehydration is one of the main risk factors for kidney stones, which can damage your kidneys if not treated promptly. If you’re prone to kidney stones, fasting may increase the chance of developing them, especially if you’re unable to stay hydrated.
2. Reduction in kidney function
The effect of fasting on kidney function depends largely on how advanced your CKD is. People with Stage 1-2 CKD typically have a lower risk of significant harm, while those with Stage 3 CKD may face a moderate risk. If you’re in Stage 4 or 5, there is a much higher risk of your kidney function declining with fasting.
While it’s unclear whether high blood pressure makes fasting riskier for your kidneys, if your blood pressure isn’t well-controlled, fasting may not be the best option (1). Similarly, if you have cardiovascular disease, it’s generally advised to avoid fasting due to the potential risk of blood clots (4).
3. Low and high blood sugar levels
Around 1 in 3 individuals with CKD also have diabetes (5). If you take medication for diabetes, especially insulin or other blood sugar-lowering medications, you may need to adjust your medication during fasting. Taking your usual medication without modification can lead to dangerously low blood sugar levels (hypoglycemia or hypo). If you have Type 1 diabetes, it’s crucial that you don’t stop taking insulin, as this can lead to diabetic ketoacidosis (DKA), a serious and potentially life-threatening condition.
On the other hand, eating large meals to break your fast may cause a sharp increase in blood sugar levels (hyperglycemia). You can help manage this by aiming for balanced meals at iftar that include complex carbohydrates, lean proteins, and healthy fats.
4. Lethargy
Fasting can result in changes to both your eating and sleeping patterns, which may leave you feeling more fatigued or mentally drained. While these effects can happen, they are usually temporary and tend to resolve once fasting ends.
5. Electrolyte imbalances
Electrolytes—like sodium, potassium, magnesium, and calcium—are essential for bodily functions. Fasting can sometimes lead to imbalances so your healthcare provider may suggest monitoring your electrolytes more closely during Ramadan, which may involve more frequent blood tests.
6. Anxiety
Fasting can sometimes bring up feelings of stress or anxiety for some people, especially when you’re juggling fasting with managing CKD. These feelings are often temporary and can lessen as your body adjusts. It’s important to practice self-care during this time and reach out to support networks when you need them.
Consulting with your healthcare team
If you’re considering fasting during Ramadan and you have CKD, your healthcare team can be an invaluable resource in helping you make the right choice for your health. They can guide you through the decision-making process and assist with any necessary adjustments to your CKD management plan if you decide to fast.
Here’s how your healthcare team can support you:
1. Assessing Your Risk
Your healthcare team can conduct a personalised risk assessment, taking into account your specific CKD stage, any other health conditions, and individual circumstances. This will help them determine your level of risk and guide you accordingly.
2. Ramadan-Focused Education
If you have diabetes and there are any Ramdan-focused education programs available in your area, your team may recommend attending one before Ramadan begins. These programmes can provide valuable insights into fasting safely with diabetes and help you prepare for the experience.
3. Adjusting Your Monitoring Plan
Your healthcare team can suggest changes to how often you monitor key health markers, such as blood pressure or blood sugar. They may also recommend more frequent check-ins for blood tests to ensure your health stays on track throughout Ramadan.
4. Modifying Your Medication Plan
If needed, your healthcare team can help adjust the doses of your medications to ensure they’re right for your needs during Ramadan. This can help keep you safe while you’re fasting.
5. Reviewing When to Break Your Fast
Your team will also guide you on the specific signs or symptoms that would indicate you need to break your fast immediately. This advice will be tailored to your circumstances to ensure your safety and well-being.
6. Personalised Recommendations for Fluid and Physical Activity
Your healthcare team can offer tailored advice on how to manage your fluid intake and physical activity during Ramadan, ensuring that these adjustments are in line with your health needs.
By working closely with your healthcare team, you can approach fasting during Ramadan with confidence, knowing that your health is being carefully monitored and supported.
Tips to fast safely & minimise health risks during Ramadan
If you’ve chosen to fast this holy month, it’s important to approach it thoughtfully and with care. Here are some tips to help you fast safely, protecting both your kidneys and your overall health and well-being:
Listen to Your Body: Monitoring Symptoms
It’s essential to be in tune with how you’re feeling throughout the fasting hours. Watch out for any signs of dehydration or low blood sugar, including:
- Thirst and dry mouth
- Dizziness or weakness
- Headaches
- Excessive hunger, sweating, or shaking
These symptoms can signal that your body is struggling and may need attention. Pay close attention to how you feel, and don’t hesitate to seek help if you’re unsure.
Keep an Eye on Blood Pressure
Regularly monitoring your blood pressure is crucial, particularly if your healthcare team has recommended more frequent checks during Ramadan. Make sure to note your readings along with any symptoms of high or low blood pressure. Keeping track of these can help you catch any potential issues early.
Blood sugar Monitoring
For those living with diabetes, it’s important to check your blood sugar levels more frequently during Ramadan, as fasting can impact your levels. Continuous sugar monitoring or additional finger-prick tests may be advised. Track your readings, especially if you experience episodes of low or high blood sugar. This will help you understand how your body responds and what adjustments might be necessary.
Stay Hydrated
Adequate hydration is key during Ramadan. Drink plenty of water during the non-fasting hours, aiming for at least 1.5-2 litres throughout the night. Spread this out across the evening, and avoid consuming too much water all at once when breaking your fast, as it can lead to overhydration.
You can also track your hydration by monitoring your weight daily and watching for signs of dehydration such as dry mouth, dark urine, or persistent thirst. These signs can help you stay on top of your hydration levels.
Know When It’s Time to Break Your Fast
Your health is the top priority. There are certain conditions where it’s important to break your fast immediately, and these should be discussed with your healthcare team. General guidelines include:
- Experiencing fever, vomiting, or diarrhoea
- Needing hospitalisation
- Developing acute kidney injury
- Blood sugar levels reaching 16.6 mmol/l or higher, or dropping below 3.9 mmol/l
- Missing important medication, like immunosuppressants for those with kidney transplants
Always prioritise your health and listen to the advice of your doctor if you feel unwell.
Consider a Trial Fast
To see how your body responds, it can be helpful to do a trial fast before Ramadan begins. If you’ve made adjustments to your medication or monitoring plan, testing how well you tolerate fasting in the days leading up to Ramadan can provide valuable insight and help you prepare safely.
Don’t Skip Suhoor (Pre-Dawn Meal)
Suhoor is a vital meal that provides your body with the energy and nutrients it needs for the day ahead. A well-balanced suhoor will help stabilise your blood sugar and keep you feeling full for longer. Focus on low glycemic index (GI) foods like wholegrain cereals, oats, and lentils, which provide a slow release of energy. Add protein-rich foods such as eggs, beans, or yoghurt, and some fruit or vegetables for extra nutrients.
Don’t forget to hydrate with plenty of water and limit caffeine, sugary drinks, or anything that may increase dehydration.
Eat Mindfully at Iftar (Breaking Your Fast)
Iftar is a time to replenish your body, but it’s important to approach it with care. Break your fast gradually: start with a glass of water, followed by a light snack like dates (in moderation), and then enjoy a well-balanced main meal. Dates can be a sweet way to start, but remember they are high in sugar, so keep them to a minimum.
Aim for a balanced meal that includes lean protein, like lentils, chicken, or fish, along with vegetables, healthy fats (such as olive oil and nuts), and low GI carbs like whole grains. If you’re on a specific diet for CKD, such as low-salt or low-potassium, make sure to continue to follow those recommendations.
Avoid Excessive Heat Exposure
During Ramadan, especially in the summer months, prolonged exposure to heat can be a concern, particularly for those with CKD. Try to limit time spent outdoors in hot weather to reduce your risk of complications. If Ramadan falls during a particularly hot season, consider fasting during a cooler time of year, if possible.
Maintain Healthy Habits Throughout Ramadan
While fasting can change your routine, it’s still important to maintain healthy habits. Stay active in ways that feel comfortable, get enough rest, eat balanced meals, be mindful of salt intake, and manage portion sizes. Small adjustments to your lifestyle can help you stay on track with your health goals during this holy month.
Fasting during Ramadan with CKD Stage 3 or 4 presents unique challenges. It’s crucial to consult with your healthcare provider to assess your risks, and if it is considered safe for you to fast, they can develop a personalised plan that includes monitoring, hydration goals, and any adjustments to medication. If you are advised against fasting during the full month of Ramadan, there are various alternative ways to consider so you can observe the spirit of Ramadan while protecting your kidney function.
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Disclaimer: This advice is primarily for individuals with CKD Stages 3 & 4. It is solely educational and provides general advice only. It is not a substitute for seeing a registered dietitian or another qualified healthcare professional.
