The Beauty of Individualize Peritoneal Dialysis Prescription by Using Incremental Peritoneal Dialysis during Ramadan Fasting

Author(s): Abdullah K. Alhwiesh, Mahmood Alnokeety, Hend Aljenaidi Ibrahiem Saeed Abdul- Rahman, Mohammed Ahmad Nasreldin, Abdelgalil Moaz Mohammed, Alauldine Khalaf Alhowaish, Abdulla Abdulrahman, Sarah Al-Warthan, Nadia Al-Oudah.

Fasting, which mandates abstinence from food and water from dawn to sunset, can sometimes be challenging for patients, particularly in countries with a high-temperature climate. Several Muslim patients with ESRD are maintained on peritoneal dialysis worldwide, with the vast majority of them wishing to fast during the month of Ramadan. Although such patients are not obliged to fast from the religious point of view, they still wish to fast to fulfill their spiritual needs and social pressure despite the advice of contrary, and here comes Shared decision -making as a cornerstone of a patient-centered approach, based on patient preferences, values, and benefits versus harms of different treatment modalities. Data in this matter is scarce, with a considerable gap in the literature. The aim of this prospective cohort study to evaluate the safety and outcomes of Ramadan fasting by using incremental automated peritoneal dialysis (APD) and compare it to full-dose APD in a single PD center. The study included 56 adult PD patients who fasted for 30 days between April 12th and May 12th, 2021. The primary outcomes were hospitalization rate, all-cause mortality, and reduction of residual renal function, whereas the secondary outcomes included other important variables such as fluctuation in dry weight, episodes of hypoglycemia and hyperglycemia, hyperkalemia, serum albumin, peritonitis, and exit site infection. Results: There were only significant differences in Serum albumin (95% CI -0.337, -0.081; p 0.002) and CO2 (95% CI 0.88, 2.84; p 0.001) before and after Ramadan fasting. The body weight after Fasting Ramadan (79.31±14.88) was lower than the body weight before Fasting Ramadan (80.78±15.23), but it was not statistically significant (p 0.090). The average daily urine output (an estimate of residual renal function) was 1044.3 ± 764 mL before Ramadan and 1155 ± 797.1 mL after 4 weeks of fasting. The average weight gain was 1.67 ± 1.347 kg. The total weekly Kt/V was 2.3228 ± 0.80160 initially and 2.3033 ± 0.83 after Ramadan fasting. Conclusion: By using incremental PD in a selected group of patients with end stage renal failure in peritoneal dialysis who had a good residual renal function and stable clinical condition, Ramadan fasting can be safe and beneficial, providing that patient strictly adhere to diet, medications, and dialysis prescription. Affiliation

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