El-Wakil Hala S, Desoky Iman, Lotfy Nashaat, Adam Ahmed G
Nephrology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Saudi J Kidney Dis Transpl. 2007 Sep;18(3):349-54.
Ramadan is the ninth lunar month of the Islamic calendar. During Ramadan, Muslims abstain from food and drink from dawn to sunset (fasting) to express their gratitude to God; eating and drinking is permitted only at night. Muslims typically consume two meals each day, one after sunset, and the other just before dawn. The effect of fasting during the month of Ramadan on patients with renal impairment is still a matter of controversy. This is a prospective study performed on 15 predialysis chronic kidney disease (CKD) patients and six healthy volunteers as control. They were studied during two phases: when the subjects were drinking and eating freely before the start of Ramadan, and a second phase toward the end of Ramadan. We estimated glomerular filtration rate (GFR) using DTPA dynamic renal scan, and tubular cell damage by measuring the level of N-acetyl-B-D- glucosaminidase (NAG). The change in glomerular filtration rate was -6.56 +/- 31.10 in the CKD group compared to 9.58 +/- 30.10 in the control group with no significant difference between them (p= 0.43). However, the urinary NAG percentage change was found to be significantly higher in the CKD patients compared to the control group (236 +/- 332, -49.1 +/- 60.1 respectively p= 0.03). There was a significantly positive correlation between the NAG values and the change in the blood glucose level (p=0.001), hence diabetic CKD patients should be meticulously followed during Ramadan fasting. In conclusion, fasting Ramadan may have injurious effect on the renal tubules in CKD patients. Larger studies are recommended to determine the extent of tubular injury and renal function in CKD patients during Ramadan fasting.
斋月是伊斯兰历的第九个阴历月。在斋月期间，穆斯林从黎明到日落禁食禁饮（斋戒），以表达对真主的感恩；仅在夜间允许饮食。穆斯林通常每天吃两餐，一餐在日落后，另一餐在黎明前。斋月期间禁食对肾功能不全患者的影响仍存在争议。这是一项针对15例透析前慢性肾脏病（CKD）患者和6名健康志愿者作为对照进行的前瞻性研究。他们在两个阶段接受研究：在斋月开始前受试者自由饮食时，以及在斋月快结束时的第二阶段。我们使用二乙三胺五乙酸（DTPA）动态肾扫描估算肾小球滤过率（GFR），并通过测量N-乙酰-β-D-氨基葡萄糖苷酶（NAG）水平评估肾小管细胞损伤。CKD组肾小球滤过率的变化为-6.56±31.10，而对照组为9.58±30.10，两组之间无显著差异（p = 0.43）。然而，发现CKD患者尿NAG百分比变化显著高于对照组（分别为236±332、-49.1±60.1，p = 0.03）。NAG值与血糖水平变化之间存在显著正相关（p = 0.001），因此糖尿病CKD患者在斋月禁食期间应受到密切关注。总之，斋月禁食可能对CKD患者的肾小管有损害作用。建议开展更大规模的研究以确定CKD患者在斋月禁食期间肾小管损伤和肾功能的程度。
