Long Term Association of Ramadan Fasting and Renal Function in Patients with Chronic Kidney Disease

Document Type : Original Article

Authors

1 Transplant research center, Clinical research institute, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

4 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

5 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

6 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

7 Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran

8 International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran

9 Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK

10.30476/ijns.2025.105096.1383

Abstract

Background: Throughout Ramadan fasting (RF), muslims strictly avoid eating, drinking, and sexual intercourse together with other actions. This study aimed to determine the long-term association of RF with renal function and blood urea nitrogen (BUN) in patients with chronic kidney disease (CKD).
Methods: In a cross-sectional study, 8725 individuals from Mashad Cohort Study were enrolled during a period of 10 years and followed through 3-year intervals to moderate the risk of losing contact. To asses renal function, glomerular filtration rate (GFR), BUN and creatinine were measured. RF was evaluated by a 16-item questionnaire. CKD was defined by National Kidney Foundation guideline as GFR<60 ml/ min/1.73 m2. Patients were categorized in three groups based on GFR of eGFR≥60, 60-89, and <15 mL/min per 1.73 m2.
Results: The mean age was 57.4 years and 48.1% were female. There was no significant relationship between RF and GFR, but a significant relationship was observed between fasting in other months and GFR. Loss of consciousness and severe hypoglycemia were higher among those with a GFR<45. Fasting during life, RF and in months other than Ramadan was accompanied by an increase in creatinine. Age was also associated with a significant rise in creatinine and BUN levels.
Conclusion: This study suggests that patients with stable mild/moderate CKD may be allowed to fast if they are carefully monitored for their health status.

Highlights

Maryam Alinezhad-Namaghi (Google Scholar)

Maryam Saberi-Karimian (Google Scholar)

Majid Ghayour-Mobarhan (Google Scholar)

Keywords

References

  1. 1. Bakhit AA, Kurdi AM, et al. Effects of Ramadan fasting on moderate to severe chronic kidney disease: a prospective observational study. Saudi Med J. 2017;38:48. DOI: 10.15537/smj.2017.1.17566. PMID: 28042630.

    2. El-Wakil HS, Desoky I, Lotfy N, et al. Fasting the month of Ramadan by Muslims: could it be injurious to their kidneys? Saudi J Kidney Dis Transpl. 2007;18:349-54. PMID: 17679744.

    3. Dogan I, Eser B, Kayadibi H. The effect of Ramadan fasting on renal functions in patients with chronic kidney disease. Turk J Biochem. 2019;44:189-96. DOI: 1515/tjb-2018-0373

    4. Salti I, Bénard E, Detournay B, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004;27:2306-11. DOI: 10.2337/diacare.27.10.2306. PMID: 15451892.

    5. Amiri S, Danish MH, Al Falasi R, et al. Combined Effect of Ramadan Intermittent Fasting and COVID-19 Lockdown on Weight, Dietary and Lifestyle Patterns. Int J Nutr Sci. 2025;10:228-243. DOI: 10.30476/ijns.2025.104373.1356.

    6. Ahmadi A, Hajiani N, Keshavarzi S. Anthropometric Index and Diet Pattern of Fasting Men in Khvormuj. Int J Nutr Sci. 2017;2:27-32.

    7. Bikbov B, Purcell CA, Levey AS, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395:709-33. DOI: 10.1016/S0140-6736(20)30045-3. PMID: 32061315.

    8. Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. 2022;12:7-11. DOI: 10.1016/j.kisu.2021.11.003. PMID: 35529086.

    9. Salahshornezhad S, Sabet Ghadam O, Akbarzadeh M, et al. Advanced Glycosylation End Products: Effects in Chronic Kidney Disease and Related Disorders. Int J Nutr Sci. 2023;8:1-8. DOI: 10.30476IJNS.2023.97806.1223.

    1. Mazloom Z, Mahmoodi M, Hejazi N. Comparing the Effect of a 40-Day Diet of Animal-based and Vegetable-based Protein in Patients with Chronic Kidney Disease under Hemodialysis; A Randomized Clinical Trial. Int J Nutr Sci. 2017;2:43-50.
    2. Dehghani A, Alishavandi S, Nourimajalan N, et al. Prevalence of chronic kidney diseases and its determinants among Iranian adults: results of the first phase of Shahedieh cohort study. BMC Nephrol. 2022;23:203. DOI: 10.1186/s12882-022-02832-5. PMID: 35681145.
    3. Levin A, Stevens PE, Bilous RW, et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inte Suppl. 2013;3:1-150. DOI: 10.1038/kisup.2012.73.
    4. Bello AK, Alrukhaimi M, Ashuntantang GE, et al. Complications of chronic kidney disease: current state, knowledge gaps, and strategy for action. Kidney Int Suppl. 2017;7:122-9. DOI: 10.1016/j.kisu.2017.07.007. PMID: 30675426.
    5. Aghasadeghi K, Zarei-Nezhad M, Keshavarzi A, et al. The prevalence of coronary risk factors in Iranian lor migrating tribe. Arch Iran Med. 2008;11:322-5. PMID: 18426325.
    6. Mostaghni AA, Soltanian A, Mokhtari E, et al. Seroprevalence of hepatitis B virus among hemodialysis patients in Bushehr province, southern Iran: HBV seroprevalence in hemodialysis patients. Hepat Mon. 2011;11:200-2. PMID: 22087144.
    7. Sadeghi SM, Sadeghi F, Akhlaghi M. Effect of Zinc Supplementation on Weight and Food Intake in Patients under Hemodialysis. Int J Nutr Sci. 2019;4:71-77. DOI:10.30476/IJNS.2019.81548.1009.
    8. Mozaffarirad N, Ahmadababdi A, Khadem Rezaiyan M, et al. The Role of Non-Governmental Organization in Providing Food Needs in Burn Patients . Int J Nutr Sci. 2021;6:104-109. DOI: 10.30476/IJNS.2021.90913.1131.
    9. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med. 1999;130:461-70. DOI: 10.7326/0003-4819-130-6-199903160-00002. PMID: 10075613.
    10. Guerrero-Morilla R, Ramírez-Rodrigo J, Ruiz-Villaverde G, Sánchez-Caravaca M, Pérez-Moreno BA, Villaverde-Gutiérrez C. Endocrine-metabolic adjustments during Ramadan fasting in young athletes. Arch Latinoam Nutr. 2013;63:14-20. PMID: 24171224.
    11. Trepanowski JF, Bloomer RJ. The impact of religious fasting on human health. Nutr J. 2010;9:57. DOI: 10.1186/1475-2891-9-57. PMID: 21092212.
    12. Ünalacak M, Kara IH, Baltaci D, Erdem Ö, Bucaktepe PGE. Effects of Ramadan fasting on biochemical and hematological parameters and cytokines in healthy and obese individuals. Metab Syndr Relat Disord. 2011;9:157-61 .DOI: 10.1089/met.2010.0084. PMID: 21235381.
    13. Vardarli MC, Hammes HP, Vardarli I. Possible metabolic impact of Ramadan fasting in healthy men. Turk J Med Sci. 2014;44:1010-20. DOI: 10.3906/sag-1308-30. PMID: 25552155.
    14. Khedmat H, Taheri S. Ramadan fasting and transplantation: current knowledge and what we still need to know. Saudi J Kidney Dis Transpl. 2010;21:417-20. PMID: 20427861.
    15. Al Wakeel JS. Kidney function and metabolic profile of chronic kidney disease and hemodialysis patients during Ramadan fasting. Iran J Kidney Dis. 2014;8:321-8. PMID: 25001139.
    16. Bernieh B, Al Hakim MR, Boobes Y, et al. Fasting Ramadan in chronic kidney disease patients: clinical and biochemical effects. Saudi J Kidney Dis Transpl. 2010;21:898-902. PMID: 20814128.
    17. Mbarki H, Tazi N, Najdi A, et al. Effects of fasting during Ramadan on renal function of patients with chronic kidney disease. Saudi J Kidney Dis Transpl. 2015;26:320-4. DOI: 10.4103/1319-2442.152494. PMID: 25758882.
    18. Ghayour-Mobarhan M, Moohebati M, Esmaily H, et al. Mashhad stroke and heart atherosclerotic disorder (MASHAD) study: design, baseline characteristics and 10-year cardiovascular risk estimation. Int J Public Health. 2015;60:561-72. DOI: 10.1007/s00038-015-0679-6. PMID: 25943424.
    19. Zomorrodian D, Khajavi-Rad A, Avan A, et al. Metabolic syndrome components as markers to prognosticate the risk of developing chronic kidney disease: evidence-based study with 6492 individuals. J Epidemiol Community Health. 2015;69:594-8. DOI: 10.1136/jech-2014-205160. PMID: 25631859.
    20. Alinezhad-Namaghi M, Nematy M, Sahranavard T, et al. Development and Validation of Ramadan Fasting Basic Information and Nutritional Habits Questionnaire. J Nutr Fasting Health. 2022;10:305-10. DOI: 10.22038/JNFH.2023.69765.1417.
    21. Alinezhad-Namaghi M, Saberi-Karimian M, Golzar M, Darroudi S, Tanbakoochi D, Esmaily H, et al. Ramadan Fasting Basic Information and Nutritional Habits among MASHAD Study Population. J Nutr Fasting Health. 2023;11: 67-72. DOI: 10.22038/JNFH. 2023.71215.1433.
    22. Hassan S, Hassan F, Abbas N, et al. Does Ramadan fasting affect hydration status and kidney function in CKD patients? Ann Nutr Metab. 2018;72:241-7. DOI: 10.1159/000486799. PMID: 29518785.
    23. Kara E, Sahin OZ, Kizilkaya B, et al. Fasting in Ramadan is not associated with deterioration of chronic kidney disease: a prospective observational study. Saudi J Kidney Dis Transpl. 2017;28:68-75. DOI: 10.4103/1319-2442.198140. PMID: 28098105.
    24. Trabelsi K, Stannard SR, Maughan RJ, et al. Effect of resistance training during Ramadan on body composition and markers of renal function, metabolism, inflammation, and immunity in recreational bodybuilders. Int J Sport Nutr Exerc Metab. 2012;22:267-75. DOI: 10.1123/ijsnem.22.4.267. PMID: 22855788.
    25. Karatas A, Canakci E, Arici YK, et al. The effect of fasting during Ramadan on the kidney functions of stage III-IV chronic kidney disease patients. Pak J Med Sci. 2021;37:972-978. DOI: 10.12669/pjms.37.4.3661. PMID: 34290768.
    26. NasrAllah MM, Osman NA. Fasting during the month of Ramadan among patients with chronic kidney disease: renal and cardiovascular outcomes. Clin Kidney J. 2014;7:348-53. DOI: 10.1093/ckj/sfu046. PMID: 25349694.
    27. Tarabeih M, Qaddumi J, Hamdan Z, et al. Increasing Overnight Fluid Intake and Kidney Function During Ramadan Fasting: A Randomized Controlled Trial. Transplant Proc. 2023;55:80-86. DOI: 10.1016/j.transproceed.2022.10.059. PMID: 36549977.
    28. Bragazzi NL. Ramadan fasting and chronic kidney disease: a systematic review. J Res Med Sci. 2014;19:665-76. PMID: 25364369.
    29. Emami-Naini A, Roomizadeh P, Baradaran A, et al. Ramadan fasting and patients with renal diseases: A mini review of the literature. J Res Med Sci. 2013;18:711. PMID: 24379850.
    30. Chowdhury A, Khan H, Lasker SS, et al. Fasting outcomes in people with diabetes and chronic kidney disease in East London during Ramadan 2018: The East London diabetes in Ramadan survey. Diabetes Res Clin Pract. 2019;152:166-70. DOI: 10.1016/j.diabres.2019.05.022. PMID: 31150726.
    31. Ahmad S, Chowdhury TA. Fasting during Ramadan in people with chronic kidney disease: a review of the literature. Ther Adv Endocrinol Metab. 2019;10: 2042018819889019. DOI: 10.1177/2042018819889019. PMID: 31798822.
International Journal of Nutrition Sciences
Volume 10, Issue 4 - Serial Number 4
December 2025
Pages 622-629

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