Ramadan: Is Fasting Safe with Kidney Disease

We’re approaching the most sacred time of the year in Islamic culture – the month of Ramadan. There are over 3 million Muslims now living in the UK, some of whom will be living with kidney disease and asking themselves – is fasting safe for my kidneys? We’ll be addressing this question in our blog post, highlighting some of the issues that you may wish to consider and provide some tips on how best to have a healthy Ramadan if you have kidney disease.


What is Ramadan?

Ramadan is a time for spiritual discipline, fasting, abstaining from pleasures, extra prayer to become closer to Allah and for increased charity and generosity. It’s also a time to gather and celebrate with family and friends. It really is a much loved time of the year for Muslims.


During the entire month of Ramadan, Muslims fast every day from dawn to sunset. Fasting includes abstaining from eating any food and drinks (including water), smoking cigarettes, engaging in any sexual activity, taking medication (that includes swallowing a pill dry) and chewing gum.


Fasting during Ramadan is one of the five pillars of Islam and considered obligatory for all healthy adult Muslims, however some people are exempt. This includes those who have a chronic illness (which could include chronic kidney disease and diabetes), and those who are frail. Despite this, some prefer not to miss these fasts in view of the special blessings and spiritual benefits. If you do choose to fast, it is wise to be aware of some of the effects of fasting on your kidneys and your overall health and what measures you can take to minimise any risks.


Potential health risks and fasting during Ramadan with kidney disease

1. Dehydration

Dehydration is one of the biggest risks of fasting with kidney disease for extended periods of time. This is particularly of concern when Ramadan falls during the summer months, when fasting times are long and weather conditions can be very hot. So who is at most risk of the effects of dehydration?


  • People with a kidney transplant

If you are passing large volumes of urine, which is common especially in the early stages post transplant, you will likely be advised to consume plenty of fluids. This could be anywhere from 3 litres up to 6 litres per day! Abstaining from fluids during daylight hours, may make this very difficult to achieve. If you become dehydrated it can damage your transplanted kidney. However people with a stable and functioning transplant who are passing normal amounts of urine, are less likely to be affected by this.


  • Chronic kidney disease

There may be a risk of dehydration causing acute kidney injury (this is a sudden drop in kidney function that may or may not bounce back) in people fasting with kidney disease. The risk is likely to be greater in those withKidneydisease stages 3-5. However the studies that have been carried out looking at this are small, limited and do report conflicting results so it is difficult to draw any firm conclusions.


  • People who are prone to kidney stones

Dehydration is a major risk factor in the formation of kidney stones, which can lead to kidney damage if not treated in a timely fashion. Therefore people who are prone to kidney stones could be at risk of stone formation if they become dehydrated.


2. Hypoglycaemia (low blood glucose/sugar levels)

Around 40% of people with kidney disease, also have diabetes. If you have diabetes and you’re on any blood glucose lowering medication, you should consult with your healthcare team on whether this should be adjusted during Ramadan.


Continuing to take normal doses of this medication AND fasting will put you at risk of your blood glucose levels dropping. However, if you have type 1 diabetes, you should not stop taking your insulin as this can cause diabetic ketoacidosis (DKA) which can be life-threatening.


It is therefore essential that anyone with diabetes, who is prescribed medication for their diabetes, seek advice from their healthcare team before fasting.


3. Reduced energy intake and lethargy

As the number of meals eaten is reduced, this can lead to eating less calories and some loss of body muscle and fat. However these changes are usually small and are often reversed once the period of fasting is over.


4. Severe hyperglycaemia (high blood glucose/sugar levels)

Eating very large meals when breaking a fast can lead to raised blood glucose levels after your mealtime. Meals should be well balanced and contain some lean protein (eg beans, eggs, lentils, pulses, fish, chicken, lean red meat), carbohydrates with a low glycaemic index as these release glucose slowly into the blood (eg wholegrain bread, brown rice, wholewheat pasta) and plenty of vegetables/salad.


6 tips to minimise health risks during Ramadan

If you still choose to go ahead and fast during this holy month, here are a few tips to follow to help minimise any negative effects to your health

1. Discuss your intent to fast with your healthcare team: talk to your team in advance as they may need to adjust medications and/or wish to monitor you more frequently.


2. Recognise symptoms: be aware of how you feel. If you have one of the following symptoms you may be dehydrated or have low blood glucose levels:


ThirstyExtreme hunger
Dry mouthSweating
Dizzy or light-headedShaking
Weakness and tirednessAnxiety


3. Know when to stop fasting: if you experience any of the above symptoms, you should check your blood glucose levels (if you have diabetes), be prepared to break your fast and receive any necessary treatment to prevent further ill health. If blood glucose levels are ⩽4 mmol/l, you should break your fast immediately.


4. Monitor regularly: keep an eye on your blood pressure, check for any of the symptoms listed above and if you have diabetes, you may want to test your blood glucose levels more often than normal


5. Eat and drink appropriately after the fast: try not to drink too much fluid immediately as this can cause overhydration and fluid overload. Drink to thirst, spread out your fluid intake but try to aim for 1.5-2 litres (if you are not on a fluid restriction). If you have diabetes, eat a meal containing carbohydrates with a low glycaemic index eg. brown rice, whole grain bread, beans and vegetables. If you are on a renal dietary restrictions for your kidney disease, continue to follow your renal diet during Ramadan.


6. Maintain healthy habits during Ramadan: continue to stay active (eg a relaxed walk during fasting or more active exercise during non-fasting period), sleep well, limit sugary treats, be careful of eating too much salt, control your portion sizes and avoid over-indulgence.


We hope that you have found this blog post useful! Here’s a quick summary:

  • If you have chronic kidney disease, you may be exempt from fasting. You may choose to discuss this with your local imam.
  • If you still choose to fast, discuss this with your healthcare team first.
  • Be aware of some of the potential health risks of fasting and educate yourself about what you can do to minimise them.

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