Fasting during Ramadan and acute kidney injury (AKI): a retrospective, propensity matched cohort study

Abstract

Background During the month of Ramadan, Muslims abstain from daytime consumption of fluids and foods, although some high-risk individuals are exempt. Because fasting's effects on the risk of acute kidney injury (AKI) have not been established, this study assesses the relationship between fasting and risk of AKI and identifies patients at high risk. Methods A single-center, retrospective, propensity-score matched, cohort study was conducted with data collected from adult patients admitted to the emergency room during Ramadan and the following month over two consecutive years (2016 and 2017). AKI was diagnosed based on the 2012 definition from the Kidney Disease: Improving Global Outcomes clinical practice guideline. Multivariable logistic regression analyses were used to examine the correlation and measure the effect of fasting on the incidence of AKI, and assess the effect of different variables on the incidence of AKI between the matching cohorts. Results A total of 1199 patients were included; after matching, each cohort had 499 patients. In the fasting cohort, the incidence of AKI and the risk of developing AKI were significantly lower (adjusted odds ratio (AOR) 0.65;95% confidence interval (CI) 0.44–0.98). The most indicative risk factors for AKI were hypertension (AOR 2.17; 95% CI 1.48–3.18), history of AKI (AOR 5.05; 95% CI 3.46–7.39), and liver cirrhosis (AOR 3.01; 95% CI 1.04–8.70). Patients with these factors or most other comorbidities in the fasting cohort had a lower risk of AKI as compared with their nonfasting counterparts. Conclusion The data show a strong reduction in the risk of developing AKI as a benefit of fasting, particularly in patients with comorbid conditions. Therefore, most patients with comorbid conditions are not harmed from fasting during Ramadan. However, larger prospective studies are needed to investigate the benefit of fasting in reducing the risk of developing AKI.

Burden and Patterns of Medical Emergencies during Ramadan Fasting: A Narrative Review

“…Also, the relationship between fasting and the risk of AKI and identified patients at high risk was assessed in a single-center, retrospective, propensity-score-matched cohort study using data collected from adult patients admitted to the ED during Ramadan the following month over two consecutive years (2016 and 2017). 60 A total of 1,199 patients were included; each cohort had 499 patients after matching. In the fasting cohort, the incidence of AKI and the risk of developing AKI were significantly lower (adjusted odds ratio [AOR] 0.65).…”

Review of the Literature on Ramadan Fasting and Health in 2022

“…[34][35][36][37] The first study assessed the relationship between fasting and the risk of acute kidney injury (AKI) to identify patients at high risk in a single-center, retrospective, propensity-score-matched cohort design. 34 Data were collected from adult patients admitted to the emergency room during Ramadan and the following month over two consecutive years (2016 and 2017). A total of 1,199 patients were included; each cohort had 499 patients after matching.…”

Religious fasting and its impacts on individual, public, and planetary health: Fasting as a “religious health asset” for a healthier, more equitable, and sustainable society

“…In Turkish patients (45 fasters and 49 non-fasters CKD, stages 3-5), Kara et al ( 93 ) found no significant changes in eGFR between non-fasters and fasters; however, individuals above the age of 72 appeared to be at a higher risk of renal function impairment than CKD patients under the age of 64. Recently, a retrospective study of 1,199 patients, who were not exempt from Ramadan fasting for 2 years (2016 and 2017), showed fasting significantly reduced the risk of developing ARF, particularly in patients with comorbidities ( 94 ). The authors concluded that Ramadan fasting conferred no negative effects on the majority of patients with comorbid disorders ( 94 ).…”

“…Recently, a retrospective study of 1,199 patients, who were not exempt from Ramadan fasting for 2 years (2016 and 2017), showed fasting significantly reduced the risk of developing ARF, particularly in patients with comorbidities ( 94 ). The authors concluded that Ramadan fasting conferred no negative effects on the majority of patients with comorbid disorders ( 94 ). Similarly, following Ramadan fasting, no significant impairment in renal function was found in autosomal dominant polycystic disease patients with early CKD ( 95 ).…”