Ramadan and Kidney disease (RaK) risk assessment tool. Potential Risk Calculator for Evaluating the Risk of Ramadan Fasting In Chronic Kidney Disease patients
Authors: Boobes Yousef , Nagelkerke Nico , Alkindi Fatima , Afandi Bachar , Abdelbaki Hanan , Mahmoud Esraa Abdelkhalig , Almeqbaali Fatima Yousef , Alyahyaei Mahra Ibrahim , Sahyouni Jamal Eldin , Al-Kuwaiti Aysha Abdulla , Abukhater Abdallah , Albloushi Aamna Ghanim , Alshehyari Amal Mohammed , Al Shukri Sara Fadel , Alketbi Rudina Mubarak , Alaryani Maitha Sultan , Alketbi Fatima Ali , Al Ahbabi Amna Mohammed , Fahmawee Toqa Abdel Rahman , Alantall Waad Mashaal , Yahya Noor Abdullah , Baynouna AlKetbi Latifa Mohammad 
Published: February 2025

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.