As people fast in this month and the whole physiology of body changes during Ramadan which may be problematic for some people, today I will be discussing with you some health-related issues and how to handle it during the month of Ramadan.

Particular attention is needed in patients of kidney, prostate, Diabetes, hypertension and heart diseases.

Today I will be sharing you some precautions and adjustments needed in these patients so that you can celebrate Ramadan as well as you can manage your health-related issues...

Precautions to prevent renal impairment and other health related problems during Ramadan.

• Always have Sehri and have adequate amount of water in Sehri
• If you are having pre-existing renal impairment, open Roza with water. Avoid high potassium and high phosphorus diet for example dates, apricots, fried food, nuts, cheese, soft juice etc...
• Normal people should take approximately 1.5 to 2.5 litre liquids (water, coffee, tea, etc.) during non-fasting hours from Maghrib to Sehri.
• For kidney disease patients total liquid intake should be 500-600 more than their urine output. These patients must have a strict oral fluid intake and urine output charting per day.
• Diabetic patients should preferably take their oral medication in Maghrib after opening Roza
• Diabetic patients should not skip their dinner and Sehri. If they are taking only Iftaar and no dinner and no sehri, their antidiabetic drugs and dose must be modified. These people must consult their diabetologist for their drug optimization as they will be at a greater risk for lowering of blood sugar.
• Patients with prostate symptoms may have worsening of their symptoms particularly increased frequency of passing urine during night time as people have more fluid intake in night hours. These patients must visit their urologist as some lifestyle changes and medications may improve this symptom.
• Avoid excessive salt and non-vegetarian diet particularly in patients with pre-existing renal impairment.
• Hypertensive patients must monitor their blood pressure as there is chance of hypotension during day time. The dose and timing of antihypertensive medication must be adjusted after consulting with their physician.
• Patients after renal transplant may fast safely
• There is a concern regarding chance of excessive renal stone formation and the increased risk of pain attack due to renal stone during Ramadan due to relative dehydration. But till today there is no convincing evidence that the risk of stone formation or the renal stone pain attack frequency increases due to fasting. So, people must remove this misconception that fasting increases stone problem.
• Chronic kidney disease patients on haemodialysis may face more episodes of post dialysis lowering of blood sugar, so blood sugar monitoring is warranted more keenly
• If there is rise of creatinine more than 30% of baseline level in patients with pre-existing kidney disease during fasting, these patients should avoid fasting.
• If there is appearance of symptoms like leg or face edema, breathlessness, dizziness, extreme lethargy during fasting in patients with pre-existing kidney disease, these patients should avoid fasting.
• Patients with any comorbidities like diabetes, hypertension or kidney disease, they should have 1-2 weekly follow up to their physicians during Ramadan if possible

Patients who should not fast...

• Acute kidney injury
• Acute tubular necrosis
• Uncontrolled diabetes and uncontrolled hypertension
• Chronic liver disease
• Peptic ulcer disease
• Postural hypotension
• Unstable angina

These were some salient points for general awareness. If you have any queries or doubt, please consult your doctor.

Wish you all a very happy Ramadan Mubarak..

Dr. Abhay Kumar & Dr. Aftaab