| Abstract|| |
During the month of Ramadan 1417H we studied 14 patients all transplanted with live related kidneys. All the patients were transplanted between one and seven months before the month of Ramadan. All the patients were on azathioprine and prednisolone and the mean plasma creatinine level was 95 ± 15 µmol/L. They all completed fasting the month of Ramadan successfully. Medical evaluation showed that there was no clinical adverse effect. There was no significant change in serum values of creatinine, calcium, protein, sodium, potassium, chloride, HC03, or liver function tests. There was, however, a significant elevation of total plasma proteins, urea, uric acid, hemoglobin, triglycerides, cholesterol, urinary sodium and potassium, concentration (p=<0.05). Our study shows that fasting in Ramadan during the first year of transplantation is possible, nevertheless further studies with large number of patients are necessary to confirm this specially in patients receiving cyclosporine.
Keywords: Ramadan fasting, Renal transplant recipients, First year of transplantation.
|How to cite this article:|
Ouziala M, Ouziala S, Bellaoui A, Drif M. Fasting During the First Year of Transplantation: Is it Safe?. Saudi J Kidney Dis Transpl 1998;9:440-3
|How to cite this URL:|
Ouziala M, Ouziala S, Bellaoui A, Drif M. Fasting During the First Year of Transplantation: Is it Safe?. Saudi J Kidney Dis Transpl [serial online] 1998 [cited 2018 May 26];9:440-3. Available from: http://www.sjkdt.org/text.asp?1998/9/4/440/39103
| Introduction|| |
Healthy adult muslims are required to fast in the month of Ramadan  . Renal transplanted muslims, with normal renal-function, feel well, and often ask about fasting during Ramadan and especially during the first year after transplantation. Previous studies , have been shown that well functioning renal transplants concentrate urine normally. Absy et al  have demonstrated that the humoral, metabolic, and neurogenic changes necessary for renal physiological compensatory hypertrophy is well preserved following renal transplantation. Other studies showed that fasting after the first year of transplantation has no adverse effect on renal patients.  Up till now there are no studies available on the effect of fasting on transplant recipients with the first year of transplantation. We usually advise our patients to fast after first year of transplantation. We describe a prospective study of patients who felt well and insisted to fast before completion of their first year post transplantation.
| Patients and Methods|| |
Fourteen renal transplant recipients who had completed less than 12 months since the date of their transplantation, and who insisted to fast during Ramadan of 1417H (1997) were seen weekly for the period of Ramadan and for four weeks following the end of Ramadan. They were also seen weekly over the four weeks period preceding Ramadan.
There were nine males and five females aged between 18 to 32 years with a mean age of 26.4 years. The patients were transplanted between one and seven months before Ramadan and all had normal graft function, and normal blood pressure.
All the patients were on maintenance doses of prednisolone and azathioprine at 3 mg/kg/day but not exceeding 150 mg/day. Four patients were on acebutolol and nifedipine two on acebutolol and one was on nifedipine only.
During Ramadan, recipients were advised to take prednisolone at "Imsak time" (Predawn Meal) and azathioprine after sunset "Iftar time'". Antihypertensive drugs were taken twice daily as for the immunosuppressive drugs.
Before, during and after Ramadan the following parameters were measured weekly: body weight, urine volume, standing and lying blood pressure, transplant kidney examination, and general inspection.
We measured the serum levels of: sodium, potassium, chloride, calcium, phosphorus, uric acid, urea, creatinine, bicarbonate, total protein, triglycerides, cholesterol, bilirubin, aspartate amino transferase, alanine amino transferase, alkaline phosphatase, hemoglobin, white blood cells, proteinuria, fractional excretion of sodium and hematuria.
The level of significance was determined using the Student's "t" test assuming unequal variance. The period of fasting was eleven hours and half per day for 30 days.
| Results|| |
All the 14 recipients fasted during the month of Ramadan without undue thirst, dizziness or fatigue. There were no significant changes in urine output or blood pressure [Table - 1] and the patients had no clinical adverse complaints before, during and after Ramadan. Except for urea, uric acid, total protein, triglycerides, cholesterol and hemoglobin, the biochemical serum parameters showed no significant changes [Table - 2].
[Table - 3] shows urinary parameters with a significant rise of sodium and potassium concentrations curing Ramadan and a drop in protein concentration. Urinary sodium and potassium returned to normal after Ramadan.
The fractional excretion of sodium showed a rise during and after Ramadan but this was not statistically significant.
| Discussion|| |
Our study is, to the best of our knowledge, the first to examine whether fasting during the first year after transplantation is safe. Our results are in agreement with the results found in healthy persons during fasting. ,,,, We conclude that the transplanted kidney with normal renal function has normal abilities of response to water and electrolyte deprivation, and is able to concentrate normally while fasting.
We did not find any changes in mean serum sodium, potassium, creatinine, calcium, phosphorus, chloride, bicarbonate, bilirubin, aspartate amino trasferase, alanine amino transferase, alkaline phosphatase and white blood ceils. The statistically significant rises in urea, uric acid, total protein, triglycerides and cholesterol are probably due to the more intake of foods of high protein value which is a national Algerian habit during Ramadan. The continued improvement in the mean in hemoglobin is probably due to improvement of erythropoeisis after renal transplantation (increase of erythropoietin secretion).
Urinalysis showed an increase of sodium and potassium that can be explained by changes in food types eaten during Ramadan but it was remarkable that fractional excretion of sodium showed the ability of the transplanted kidney to conserve water and salt normally during fasting.
The body weight, the blood pressure, the urine volume and the local examination of the transplanted kidney showed no significant changes. However, three patients had a weight loss and five patients had a weight gain similar to that found in healthy adults. ,
This study shows that transplanted patients with stable renal function and controlled blood pressure during the first year can observe fasting. However, this study was carried out in winter and with a small number of patients, it is clear that we need studies involving larger number of patients and fasting during summer, where the days are longer and warmer to confirm our observation. It should also be noted that none of our patients were on cyclosporine and all were living related and other studies on cadaveric transplants and on cyclosporine should be undertaken.
| References|| |
|1.||Surat al-baquarah (chapter 2) verses 183-185, The Holy Quran. |
|2.||Rashed AH, Siddiqui SA, Aburomeh SH.Clinical problems during fast of Ramadan.Lancet 1989; 1:1396. |
|3.||Bemieh BO, Mohamed AO, Wafa AM.Ramadan fasting and renal transplant recipients: clinical and biochemical effects. Saudi J Kidney Dis Transplant 1994;5(4): 470-3. |
|4.||Absy M, Metreweli C, Matthews C s AlKhader A. Changes in transplanted kidney volume measured by ultrasound. Br J Radiol 1987;60:525-9. |
|5.||Abdalla AH, Shaheen FA, Rassoul Z, et al.Effect of Ramadan fasting on Moslem kidney transplant recipients. Am J Nephrol 1997;18:101-4. |
|6.||Cheah SH, Ching SL, Husain R, DuncanMT. Effects of fasting during Ramadan onurinary excretion in Malaysian muslims. BrJNutr 1990;63:329-37. |
|7.||Rashed AH. The fast of Ramadan (Editorial). Br Med J 1992;304:521-2. |
|8.||Suliman NA, Khatib FA. Effects of Ramadan fasting on body weight and some blood constituents of healthy muslims. Nutr RepInt l988;38(6):1299-306. |
|9.||Begma IA. Khan IH. Variation in ionic concentration of blood serum during Ramadan fasting. Pakistan J Science 1990;33:354-6. |
|10.||El Hamzi MA, Al-Faleh FZ, Al-Mofteh FA.Effects of ramadan fasting and the values of hematological and biochemical parameters. Saudi Med J 1987:8:171-6. |
Renal Transplantation Unit, Reanimation Polyvalente, CHU Alger Centre Hospital, Mustapha Bacha
[Table - 1], [Table - 2], [Table - 3]