Background Fasting during Ramadan has been found safe for most chronic kidney diseases (CKD) patients but may pose risks for some. CKD patients who choose to fast require careful attention from healthcare providers. However, there is a lack of studies evaluating the impact of Ramadan fasting on various kidney diseases. The Ramadan and Kidney Disease (RaK) working group has developed a risk stratification tool to categorize CKD patients intending to fast into low, moderate, and high-risk groups. We propose a Ramadan fasting calculator incorporating key risk factors to help guide fasting decisions in CKD patients.

Methods A prospective cohort study was conducted at Ambulatory Healthcare Services from March 2024 to August 2024. The Electronic Medical Records (EMRs) of 220 patients were reviewed, supplemented by teleinterviews conducted before and after Ramadan. The primary outcomes assessed were the Ramadan fasting experience and the occurrence of significant adverse events (SAEs).

Results Among the 220 participants, 71.4% completed all 30 days of fasting during Ramadan, 7.3% began fasting but had to break it, and 21.4% did not fast. A total of 39 significant adverse events (SAEs) were recorded. This sample’s mean and median RaK scores were 9.78 and 9.0, respectively. Distribution of RaK scores was as follows: 55.5% had a score of 9 or lower, 24.5% had scores between 10 and 13, and 18.6% had scores above 13.

Ordinal regression (proportional odds model) was used to predict fasting status (categorized as 0 = no fasting, 1 = partial fasting, 2 = completed fasting). The RaK score was the only significant predictor, with an estimate of −0.159 (95% CI: −0.264 to −0.053), p = 0.003 (Figure 2). The area under the curve (AUC) for predicting the likelihood of attempting fasting was 0.715 (95% CI: 0.635–0.794), with an optimal cutoff point of 9.5.

Regarding SAE prediction using logistic regression, a higher RaK score was significantly associated with increased SAE incidence (B = 0.253, OR: 1.036–1.599, p = 0.023). Additionally, non-UAE nationality and frailty were also significantly associated with a higher risk of SAEs.

Conclusion The RaK risk assessment tool was found to be a valid predictor of fasting status and significant adverse events (SAEs) in CKD patients. This is the first validated risk assessment tool designed for CKD patients intending to fast during Ramadan. Further studies are needed to refine its applicability and provide more tailored guidance for specific subgroups of kidney patients.

Key learning points What was known:

Research on Pre-Ramadan risk assessment in relation to Ramadan fasting by kidney disease patients is lacking.

This study adds:

This is the first study to validate the RaK assessment tool developed based on multidisciplinary experts’ consensus.

The tool was effective in identifying patients at high risk of developing adverse events during fasting and in identifying patients who can fast safely.

Potential impact:

The RaK assessment tool is recommended to be included in the pre-Ramadan assessment of patients with kidney diseases.

The authors have declared no competing interest.

No funding was used in this study.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the Ambulatory Healthcare Services IRB, approval number 2024-5. Consent statement in the Ethics approval and consent to participate: Informed consent was gathered verbally during the two occasions of calling patients before and after Ramadan.

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