Effects of Ramadan Fasting on Intradialytic Hypoglycemia and Clinical Outcomes in Patients with Diabetes on Maintenance Hemodialysis: A Multicenter Prospective Cohort Study in Southern Thailand
Prospective cohort study observes minimal intradialytic hypoglycemia during Ramadan fasting in hemodialysis patients with diabetes, suggesting feasible safety under monitoring.
Key Points
To assess the association between Ramadan fasting and the risk of intradialytic hypoglycemia and other clinical complications in patients with diabetes undergoing maintenance hemodialysis.
Multicenter prospective cohort study conducted across four centers in Thailand during pre-Ramadan and Ramadan 2024, enrolling 153 patients with end-stage kidney disease and diabetes on maintenance hemodialysis.
Participants were categorized into non-fasting, partial fasting, or full fasting cohorts; all were dialyzed with 100 mg/dL glucose-containing dialysate and received standardized pre-Ramadan medication adjustments.
Primary outcome was intradialytic hypoglycemia (blood glucose <70 mg/dL), alongside secondary evaluations of hemodialysis-related complications, blood pressure, interdialytic weight gain, Kt/V, and laboratory markers.
Among 153 participants (73 non-fasting, 44 partial fasting, and 36 full fasting), zero intradialytic hypoglycemia events occurred in the full-fasting and non-fasting groups, while only one episode (0.2%) was observed in the partial-fasting group.
Hemodialysis-related complications, blood pressure, interdialytic weight gain, and dialysis adequacy (Kt/V) remained comparable across groups without significant divergence.
Serum potassium and parathyroid hormone concentrations rose during Ramadan in both the full-fasting and non-fasting groups, though neither group experienced reported adverse clinical events.