#6838 SAFETY OF RAMADAN FASTING IN DIALYSIS PATIENTS: A TUNISIAN PROSPECTIVE MULTICENTER STUDY
Authors: Bchir Sirine , Ayed Amel , Mahmoud Nouha Ben , Jaballah Lazhar , Hassine Fadoua , Chouchen Sawssen , Nouira Samir , Salem Meriem Ben , Salah Manel Ben , Mayssa Hadj Brahim , Ltaief Ahmed , Hawala Fawzi , Hammouda Mouna , Skhiri Habib , Elati Zohra , Sabra Aloui 
Published: June 2023

Abstract

Background and Aims
Hemodialysis patients are generally exempt from Ramadan Fasting (RF) because they are more vulnerable to the risk of malnutrition as well as fluid and electrolyte imbalance. In addition, many muslim hemodialysis patients feel the spirituel need to fast during Ramadan, even when they are not compelled to do so. Moreover, there are no medical recommendations that specify who should and should not fast. The aim of our study is to explore the experiences of Muslim Hemodialysis patients fasting Ramadan in Hemodialysis centers.

Method
This prospective multicenter study involved patients from eight different hemodialysis centers in Monastir and Mahdia cities. Biochemical, clinical parameters and bioimpedance monitoring were performed before, during and after Ramadan with a group of Fasting Ramadan patients (RFG) and a group of Ramadan non-fasting hemodialysis patients (RNFG). Patients in RFG did so as a personal choice and they wouldn't skip fasting on dialysis days due to fear of the side effects of fasting. Oral consent was taken from all the patients included in the study.

Results
One hundred and four (104) patients were enrolled in this study. Among them, 44 were in the RFG, and the remaining sixty (60) patients were in the RNFG. The mean age of RFG and RNFG was 47, 13 +/- 12 years and 54, 7 +/- 15 years, respectively. 32 patients (52, 3 %) were males in RFG and 38 were males (63, 3%) in RNFG.
In RFG, about 6, 8% (n = 3) and 43, 2% (n =19) had diabetes and hypertension, respectively.
The mean duration on hemodialysis was 7 +/- 6, 27 years. There were no significant differences between RFG and RNFG except in diabetic and hypertension status.
Comparing biological findings pre,during and post-fasting,in RFG, no significant differences were noted in serum sodium (135,9 +/- 4 ; 135,8 +/- 2,5 and 136,3 +/- 2,4 mmol/l respectively) ; and there were no drop in serum albumin during fasting (40,4 +/- 3,4 ; 40,8 +/- 3,7 and 40,6 +/- 4,34 g/l respectively).
However, mean serum potassium was higher during RF (5,59 +/- 0,8 ; 5,6 +/- 1 and 5,2 +/- 0,88 mmol/l respectively) and, mean serum Phosphorus was also higher during RF (1,54 +/- 0,57; 1,73 +/- 0,52 and 1,69 +/- 0,7 mmol/l respectively).
Furthermore, with bioimpedance monitoring, comparing pre, during and post Fasting, more fluid retention in patients was observed during fasting (51, 67 +/- 7; 54, 3 +/- 7, 4 and 53, 2 +/- 6 % respectively). But the mean of the inter dialytic weight gain (IDWG) remained the same (2,57 +/- 0,8 ; 2,53 +/- 0,82 and 2,61 +/- 0,7 Kg respectively), and none presented with pulmonary oedema or other emergency that might need hospitalization. However, there was positive change to body composition between pre and during fasting, shown as lower body fat mass (FM) percentage during fasting (29,4 and 28,2% respectively) and also, lower body mass index (BMI) (26,5 and 25,9 respectively).
Nevertheless, when comparing findings between RFG and RNFG, there was no significant difference in any parameters.

Conclusion
The overall conclusions suggest that fasting is relatively well tolerated by hemodialysis patients and does not affect the morbidity and mortality rates. However, careful monitoring of fluid balance, serum electrolytes, and albumin is advisable.