Kidney function profile before, during, and after Ramadan fasting in healthy elderly: a prospective cohort study
BACKGROUND Kidney function profile is one of the important parameters in determining the health of the elderly. In Indonesia, no study has been conducted on kidney function profile during Ramadan fasting to determine the safety of Ramadan fasting in the elderly. This study aimed to determine the kidney function profile in the elderly who fasted during Ramadan.
METHODS This study used a prospective cohort design. The inclusion criteria were elderly aged >60 years undergoing Ramadan fasting in Jatinegara, Jakarta from April to July 2019. Patients with end-stage renal failure who had an acute infection, hypertension crisis, or refused to participate in the study were excluded. Patients who did not fast for 3 consecutive days were dropped out. The kidney function profile was calculated by the estimated glomerular filtration rate (eGFR) using the CKD-EPI formula 1 week before the first day of Ramadan, 3 weeks after the first day of fasting, and 2 weeks after the last day of fasting. Decreased eGFR was defined as having a minimum of 20% eGFR decline during or after the fasting period. Bivariate analysis was performed using McNemar or Cochran tests.
RESULTS 2 patients had eGFR decline during fasting, and 7 patients had eGFR decline after fasting. The median eGFR before, during, and after fasting were 81.5, 88.7, and 76.8 ml/min/1.73 m², respectively. A total of 1.4% of subjects had decreased eGFR during Ramadan, while 9.1% had decreased eGFR after Ramadan. However, the changes were not statistically significant.
CONCLUSIONS Although most elderly had lower eGFR following Ramadan fasting compared to before and during Ramadan, only individuals with several comorbidities had significant changes of kidney function.
Hassan S, Hassan F, Abbas N, Hassan K, Khatib N, Edgim R, et al. Does Ramadan fasting affect hydration status and kidney function in CKD patients? Ann Nutr Metab. 2018;72(3):241-7. https://doi.org/10.1159/000486799
Hejaili F, Qurashi S, Binsalih S, Jaradt M, Al Sayyari A. Effect of repeated Ramadan fasting in the hottest months of the year on renal graft function. Nephrourol Mon. 2014;6(2):e14362. https://doi.org/10.5812/numonthly.14362
Baccouche H, Hellara I, Khochtali I, Grissa M, Boubaker H, Beltaief K, et al. Ramadan fasting effects on metabolic parameters in elderly persons with cardiovascular risk factors. J Aging Research and Lifestyle. 2014:200-5. https://doi.org/10.14283/jarcp.2014.35
Wu LW, Chen WL, Liaw FY, Sun YS, Yang HF, Wang CC, et al. Association between fluid intake and kidney function, and survival outcomes analysis: a nationwide population-based study. BMJ Open. 2016;6(5):e010708. https://doi.org/10.1136/bmjopen-2015-010708
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
Oshima M, Toyama T, Haneda M, Furuichi K, Babazono T, Yokoyama H, et al. Estimated glomerular filtration rate decline and risk of end-stage renal disease in type 2 diabetes. PLoS One. 2018;13(8):e0201535. https://doi.org/10.1371/journal.pone.0201535
WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications Australia; Melbourne: 2000.
Indonesian Endocrinologists Association (PERKENI). [Consensus on diabetes type 2 prevention and control in Indonesia]. Jakarta; PB Perkeni; 2015. Indonesian.
Seto E, Setiati S, Laksmi PW, Tamin TZ. Diagnostic test of a scoring system for frailty syndrome in the elderly according to cardiovascular health study, study of osteoporotic fracture and comprehensive geriatric assessment based frailty index compared with frailty index 40 items. Acta Med Indones. 2015;47(3):183-7.
Watson PE, Watson ID, Batt RD. Total body water volumes for adult males and females estimated from simple anthropometric measurements. Am J Clin Nutr. 1980;33(1):27- 39. https://doi.org/10.1093/ajcn/33.1.27
Gaytán-González A, Ocampo-Alfaro MJ, Torres-Naranjo F, González-Mendoza RG, Gil-Barreiro M, Arroniz-Rivera M, et al. Dietary protein intake patterns and inadequate protein intake in older adults from four countries. Nutrients. 2020;12(10):3156. https://doi.org/10.3390/nu12103156
El-Wakil HS, Desoky I, Lotfy N, Adam AG. Fasting the month of Ramadan by Muslims: could it be injurious to their kidneys? Saudi J Kidney Dis Transpl. 2007;18(3):349-54.
Bragazzi NL. Ramadan fasting and chronic kidney disease: a systematic review. J Res Med Sci. 2014;19(7):665-76.
Al Muhanna FA. Ramadan fasting and renal failure. Saudi Med J. 1998;19(3):319-21.
Setiati S, Haricahyo S, Rahardjo P, Hakim L, Supartondo S, Rahardjo TB. The effect of Ramadhan fasting on kidney function among elderly patients. Med J Indones. 2000;9(1):23-8. https://doi.org/10.13181/mji.v9i1.649
Clark WF, Huang SH, Garg AX, Gallo K, House AA, Moist L, et al. The chronic kidney disease water intake trial: protocol of a randomized controlled trial. Can J Kidney Health Dis. 2017;4:2054358117725106. https://doi.org/10.1177/2054358117725106
Das A, Hasmat N, Ghosh SK, Sahu S. Effects of Ramadan intermittent fasting and pattern of nutrients intake on BMI and MUAC of a population consisting of Indian Muslims. Biol Rhythm Res. 2021;52(8):1260-9. https://doi.org/10.1080/09291016.2019.1700328
Kiuchi A, Ohashi Y, Tai R, Aoki T, Mizuiri S, Ogura T, et al. Association between low dietary protein intake and geriatric nutrition risk index in patients with chronic kidney disease: a retrospective single-center cohort study. Nutrients. 2016;8(10):662. https://doi.org/10.3390/nu8100662
Malik S, Bhanji A, Abuleiss H, Hamer R, Shah SH, Rashad R, et al. Effects of fasting on patients with chronic kidney disease during Ramadan and practical guidance for healthcare professionals. Clin Kidney J. 2021;14(6):1524-34. https://doi.org/10.1093/ckj/sfab032
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