Impact of Ramadan fasting on nutrition, inflammation, and dialysis adequacy among hemodialysis patients

Abstract Background Fasting the holy month of Ramadan is one of the obligatory rituals in Islam. Although sick people are exempted, some insist on fasting. Several studies concerning safety and its impact on patients with different diseases have been reported. In this context, the hemodialysis population represents a special entity. The present study aimed to assess the impact of fasting on nutritional status, inflammatory status, and the adequacy of hemodialysis. Methods In this prospective cohort study, 65 hemodialysis patients were recruited from the hemodialysis unit in the Urology and Nephrology Center at Mansoura University, Egypt. The participants were divided into three groups based on different intentions to fast during Ramadan. Group 1 included 21 patients who fasted daily (DFG). Group 2 included 25 patients who fasted non-hemodialysis hemodialysis days; we referred to this group as the partial fasting group (PFG). Group 3 included 19 patients who did not fast; these patients composed the nonfasting group (NFG). Nutritional status was assessed using a subjective global assessment (SGA) and triceps skin fold thickness. The neutrophil to lymphocyte ratio (NLR), human B-cell lymphoma/leukemia2 (BCL2), and advanced glycation end products (sRAGE) were used as inflammatory markers. Hemodialysis adequacy was evaluated by KT/V and the urea reduction ratio (URR). All patient assessments were carried out before, immediately after, and 3 months after Ramadan. Results There was a significant reduction in nutritional status in all studied groups (all P