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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1994  |  Volume : 5  |  Issue : 4  |  Page : 470-473
Ramadan fasting and renal transplant recipients: Clinical and biochemical effects

Nephrology Unit, King Fahd Hospital, Madina Al-Munawarah, Saudi Arabia

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Eleven renal transplant recipients were studied while fasting during the month of Ramadan. All were asymptomatic. The serum and urinary bichemical analysis showed no significant changes. Also, there were no adverse effects on the allograft and the cyclosporine A levels did not change significantly. There was a significant elevation of serum potassium levels during fasting, but the levels always remained within normal limits. Our study indicates that fasting during Ramadan does not seem to be associated with any significant ill effects in renal transplant recipients. However, studies involving larger numbers of patients are needed to confirm this observation.

Keywords: Ramadan, Fasting, Kidney Transplantation.

How to cite this article:
Bernieh BO, Mohamed AO, Wafa AM. Ramadan fasting and renal transplant recipients: Clinical and biochemical effects. Saudi J Kidney Dis Transpl 1994;5:470-3

How to cite this URL:
Bernieh BO, Mohamed AO, Wafa AM. Ramadan fasting and renal transplant recipients: Clinical and biochemical effects. Saudi J Kidney Dis Transpl [serial online] 1994 [cited 2020 Apr 6];5:470-3. Available from: http://www.sjkdt.org/text.asp?1994/5/4/470/41140

   Introduction Top

Ramadan fasting is one of the five pillars of Islam. Healthy adult Muslims of both sexes are instructed to fast in the ninth month of each lunar year. Exemption is given to the sick, travelers, debilitated elderly people and pregnant and lactating women [1],[2] . Fasting during Ramadan is different from prolonged continuous fasting [3] in that it is done only between dawn and sunset and people are allowed to drink and eat freely after sunset till the onset of dawn [4] . Several studies have concluded that fasting during Ramadan does not have any adverse effect on healthy adults [4],[5],[6] . The safety of Ramadan fasting for non­insulin dependent and insulin dependent diabetics has also been established [7],[8],[9] . The same is true during pregnancy and lactation albeit with minor effects [10],[11] . Renal transplantation as a mode of treating end­stage renal failure is now a well established form of therapy and virtually returns these patients to normalcy. Transplant recipients are usually advised to liberalize fluid intake and are generally discouraged from fasting [13] . However, measurement of the concentrating ability of the transplanted kidneys has shown no difference from normal healthy individuals, a finding which perhaps argues against discouraging Ramadan fasting [14] .

Adult Muslims who have received renal transplantation and are keen to practice their religion often ask their doctors whether fasting is safe. There have been no studies so far to answer this question. This study was undertaken to look for symptoms, signs and biochemical abnormalities in renal transplant recipients during Ramadan fasting.

   Population and Methods Top

Out of a total of 45 renal transplant recipients who are currently being followed up at King Fahad Hospital, Madina Al-Munawarah, we studied 11 patients who voluntarily chose to fast during Ramadan in 1413 H, corresponding to February/March 1993. There were seven males aged between 17 to 50 years with a mean age of 39.9 years and four females aged between 34 to 45 years with a mean of 38.7 years. The patients were transplanted between 12 to 62 months before and the mean age of the grafts was 30 + 15.6 months. All patients had normal graft function at the time of study and had experienced fasting before the onset of their renal failure.

The patients were on maintenance doses of prednisolone, azathioprine and cyclosporine A (CyA). In the month of fasting, these drugs were taken once daily after breaking the fast at sunset. Eight patients were hypertensive of whom two were controlled with nifedipine, two with atenolol and one with captopril. Three patients were on atenolol along with captopril, prazosin or nifedipine. Anti­hypertensive treatment was taken twice daily, once after sunset and the other with the predawn meal (Sahour).

These patients were advised to come for follow-up three times during the month preceding Ramadan, three times during the month of Ramadan and another three visits in the month following Ramadan. A ten days interval was allowed between successive visits. Follow-up visits during the month of Ramadan were made at 5 PM (one hour before breaking the fast) and at 8.00 a.m. in the months before and after Ramadan. During each visit the patients' body weight, lying and standing blood pressure were measured. In the three visits during Ramadan each patient was interviewed regarding undue fatigue, dizziness or thirst compared to his previous experience. Serum levels of sodium, potassium, urea, creatinine, total protein, albumin, fasting glucose, triglycerides and cholesterol were measured. The blood CyA level, hemoglobin and total leucocyte count were monitored at each visit as also the fractional excretion of sodium (FENa) • All the samples were taken with the patients fasting for at least 12 hours.

The parametric data were analyzed using the Student's't' test assuming unequal variance.

   Results Top

None of the transplant recipients experienced any undue fatigue, dizziness, thirst or any other symptoms compared to their experience of fasting before the onset of renal failure. All the transplant recipients fasted the whole of the month of Ramadan each day from dawn to sunset. They had no particular difficulties regarding drug timing.

[Table 1] shows the mean body weight, lying and standing blood pressure and CyA levels measured before, during and after the month of Ramadan. The mean lying blood pressure showed a significant drop after Ramadan when compared with that before fasting (P = 0.013) but not when compared with that during fasting (P = 0.827). The body weight, standing blood pressure and CyA levels showed no significant changes. The mean serum values before, during and after Ramadan for sodium, potassium, urea, creatinine, total protein and albumin are shown in [Table 2]. There were no significant changes in these parameters when values during and after Ramadan fasting were compared with those before, except for serum potassium which showed a significant rise (P = 0.044) during fasting as compared with the values before Ramadan but remained within normal limits. [Table 3] shows the mean values of fasting serum glucose, triglycerides, cholesterol and the blood hemoglobin and total leucocytic count in the three periods studied. No results were available of fasting cholesterol and triglycerides in the month following Ramadan. There were no significant changes when the results during and after Ramadan fasting were compared with those before fasting.

The fractional excretion of sodium dropped as compared to the values before Ramadan but was not statistically significant [Table 4].

   Discussion Top

Fasting during the month of Ramadan which entails not taking food or drink from dawn to sunset caused no undue symptoms in 11 renal transplant recipients, eight of whom were also on anti-hypertensive treatment. This demonstrates that these "patients" are almost back to normal in respect of the demands put on the body by fasting during these hours.

The absence of significant weight change during fasting in the renal transplant recipients matches the results in healthy people observing fast [15] . However, there are reportsof both weight loss as well as weight gain in the healthy groups [4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] . These variations may be attributed to local traditions and food types consumed during the month of Ramadan.

The low mean lying blood pressure and the low but statistically not significant standing blood pressure in the month following Ramadan could not be easily explained. The FENa during Ramadan shows the ability of the transplanted kidney to conserve salt and water normally while fasting.

The lower mean blood CyA level observed during fasting was not significantly different from that before or after fasting. This finding shows that intermittent fasting for more than half the day has no significant effect on CyA levels which remained within therapeutic range.

The absence of changes in mean serum sodium, urea, creatinine, total protein and albumin during fasting or in the month following it in the renal transplant recipients studied are in agreement with the results found in healthy individuals during fasting and imply good functional abilities of the transplanted kidney [5],[14],[15] . The significant rise in serum potassium level during fasting has been reported before in healthy fasters as well [4] This may be due to the common practice of drinking large volumes of fruit juices at sunset as well as reduced potassium excretion [5] .

The changes in the fasting blood glucose were also not significant and is in agreement with results found in healthy people [4],[5],[6] as well as in insulin and non-insulin dependent diabetics [7],[8],[9] observing Ramadan fast This shows that Ramadan fasting per se has no adverse effects on glucose homeostasis. The changes observed in blood hemoglobin, total leucocytic count, fasting serum triglycerides and cholesterol were also not significant, similar to those reported in healthy adults [4],[5],[6] .

This study, although small in number shows that transplant patients with stable renal function can observe fasting during the month of Ramadan without any serious adverse effects. However, studies with larger numbers of patients are needed to confirm our findings.[19]

   References Top

1.Surah Al-Baqarah (Chapter 2) verses 183­185. The Holy Quran.  Back to cited text no. 1    
2.Sakr AH. Fasting in Islam. J Am Diet Assoc. 1975;67:17-21.  Back to cited text no. 2    
3.Insights into fasting [editorial]. Lancet 1992;339:152-3.  Back to cited text no. 3    
4.El-Hazmi MAF, Al-Faleh FZ, Al-Mofleh FA. Effects of Ramadan fasting and the values of haematological and biochemical parameters. Saudi Med J 1987;8:171-6.  Back to cited text no. 4    
5.Cheah SH, Ch'ng SL, Husain R, Duncan MT. Effects of fasting during Ramadan on urinary excretion in Malaysian Muslims Br J Nutr 1990;63:329-37.  Back to cited text no. 5    
6.Rashed AH. The fast of Ramadan[editorial]. Br Med J 1992;304:521-2.  Back to cited text no. 6    
7.Khogheer Y, Siliman MI, Al-Fayez SF. Ramadan fasting and diabetes, safety and state of control. Ann Saudi Med 1987;7:(Supp) 6-7.  Back to cited text no. 7    
8.Laajam MA. Ramadan fasting and non­insulin- dependent diabetes: effect on metabolic control. East Afr Med J 1990;67:732- 6.  Back to cited text no. 8  [PUBMED]  
9.Ahmed AF, Saleem Y, Abu-Aisha H. Ramadan fasting and insulin-dependent diabetes mellitus: effect on clinical and biochemical control. Int Diab Digest 1993;July:88-9.  Back to cited text no. 9    
10.Malhotra A, Scott PH, Scott J, Gee H, Wharton BA. Metabolic changes in Asian Muslim pregnant mothers observing the Ramadan fast in Britain. Br J Nutr 1989;61:663-72.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Prentice AM, Prentice A, Lamb WH, Lunn PG, Austin S. Metabolic consequences of fasting during Ramadan in pregnant and lactating women. Hum Nutr Clin Nutr 1983;37:(4)283-94.  Back to cited text no. 11    
12.Morris PJ. Renal transplantation: indications, outcome, complications and results. In: Schrier RW, Gottschalk CW. (eds), Diseases of the kidney (4th ed.), Boston, Little Brown, 1988;3:3211-35.  Back to cited text no. 12    
13.Jamisan RJ, Muttly RH. The urinary concentration mechanism. N Eng J Med 1976;295:1059-66.  Back to cited text no. 13    
14.Rashed AH, Siddiqui SA, Aburomeh SH. Clinical problems during the fast of Ramadan. Lancet 1989;1:1396.  Back to cited text no. 14    
15.Suliman NA, Khatib FA. Effects of fasting Ramadan on body weight and some blood constituents of healthy Muslim. Nutr Rep Int 1988;38(6):1299-306.  Back to cited text no. 15    
16.Begma IA, Khan IH. Variation in ionic concentration of blood serum during Ramadan fasting. Pakistan J Science. 1990;33:453-6.  Back to cited text no. 16    
17.Mustafa KY, Mahmoud NA, Gumaa KA, Gader AM. The effects of fasting in Ramadan. 2. Fluid and electrolyte balance. Br J Nutr 1978:40:583-9.  Back to cited text no. 17    
18.Rodriguez Iturbe B, Herrera J, Garcia R. Relationship between glomerular filtration rate and renal blood flow at different levels of protein-induced hyperfilteration in man. Clin Sci 1988;74:ll-5.  Back to cited text no. 18    
19.Cooke CR, Turin MD, Whelton A, Walker WG. Studies of marked and persistent sodium retention in previously fasted and sodium-deprived obese subjects. Metabolism 1987;36:609-15.  Back to cited text no. 19    

Correspondence Address:
Abdelrahman Osman Mohamed
Consultant Nephrologist, King Fahd Hospital, Madina Al Munawarah
Saudi Arabia
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PMID: 18583773

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  [Table 1], [Table 2], [Table 3], [Table 4]


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