Changes in biochemical, hemodynamic, and dialysis adherence parameters in hemodialysis patients during Ramadan

Abstract

This paper aimed to study the effect of Ramadan fasting on biochemical and clinical parameters and compliance for dialysis. A prospective multicenter observational cross-sectional study comparing fasting with a non-fasting stable adult hemodialysis patients for demographic and biochemical parameters, compliance with dialysis, inter-dialytic weight gain, pre- and post-blood pressure, and frequency of intradialytic hypotensive episodes was carried out. Six hundred thirty-five patients, of whom 64.1% fasted, were studied. The fasters were younger (53.3 ± 16.2 vs. 58.4 ± 16.1 years; P = 0.001) but had similar duration on dialysis (P = 0.35). More fasters worked (22.0% vs. 14.6%; P = 0.001) and missed dialysis sessions during Ramadan. No differences were noted between groups in sex, diabetic status, or dialysis shift or day. There were no differences in the pre- and post-dialysis blood pressure; serum potassium, albumin or weight gain; diabetic status; sex; and dialysis shift time or days. However, serum phosphorous was significantly higher in the fasting group (2.78 ± 1.8 vs. 2.45 ± 1.6 mmol/L; P = 0.045). There were no intragroup differences in any of the parameters studied when comparing the findings during Ramadan with those in the month before Ramadan. Fasters were significantly younger and more likely to be working, to miss dialysis sessions, and to have higher serum phosphorous levels. No other differences were observed.

The effects of Ramadan fasting on clinical and biochemical markers among hemodialysis patients: A prospective cohort study

“…After controlling for within person variation, sociodemographic and significant comorbidities (diabetic and hypertension status), we found no clinically significant differences between Ramadan fasting groups in means of the majority of biochemical variables including serum albumin, creatinine, blood urea nitrogen, phosphorus, calcium, sodium, hemoglobin, erythrocytes count, and platelets count. This accord with the findings of prior studies suggesting that, on average, Ramadan fasting by hemodialysis patients is not associated with significant clinical changes in key biochemical parameters [3, 21, 24]. The current study found that RFG and RPFG had slightly higher mean IDWG by 0.6 kg and 0.4 kg than RNFG, respectively.…”

“…The present study found a significant increase in mean serum potassium in RFG than that of RNFG suggesting that hemodialysis patients fasting daily during Ramadan may be at risk of hyperkalemia. Although, this finding differs from some previous studies [3, 21–24], which showed no significant changes in serum potassium due to Ramadan fasting in hemodialysis patients, it is consistent with the findings of another study from KSA by Al-Khader and colleagues [20]. However, no adverse effects related to hyperkalemia were reported by that study [20].…”

“…One study reported that Ramadan fasting was associated with increase in mean IDWG by 0.6 kg among Saudi hemodialysis patients [20]. Other studies reported that Ramadan fasting was associated with either decrease or no significant difference in IDWG [3, 22, 24, 25]. The underlying mechanisms for our observation of increasing mean IDWG in RFG and RPFG is not clear, as our study did not collect dietary information.…”

“…However, one potential explanation is increased consumption of Ramadan’s festive foods rich in potassium (e.g. dates, apricot, watermelon, sweets, carbonated soft drinks, squash, tea and coffee), which is traditional in Palestine and other middle eastern countries [3, 10, 20, 24]. Another explanation is insulin suppression due to fasting (insuliopenia), causing shift of potassium from the intracellular to the extracellular space [27, 28].…”

Lipids, Lipoprotein Distribution and Nutritional Parameters over the Ramadan Period in Hemodialysis Patients

“…The findings from several studies in Saudi Arabia report that poor nutritional status and high prevalence of malnutrition (among HD patients) are consistent with these observations [23,26,27]. In HD patients, changes in various clinical and biochemical parameters during R have been reported in relatively few studies, and generally no adverse effects have been noted [7,8,28]. The impact or association of any nutritional changes with changes in anthropometric or blood chemistry (including lipids) is largely unexplored.…”