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| Reference | Methods | Outcomes |
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| [34] | Retrospective study from Erzincan, Turkey on 117 fasting CKD patients (Stages 2–3) comparing those who developed AKI while fasting (n = 27) to those who did not (n = 90) during Ramadan in 2013 and 2014 | HTN and number of days fasting were significant risk factors for AKI. RAASi were not risk factor. Patients with AKI tended to be older with higher baseline creatinine and proteinuria. Patients were evaluated only during Ramadan. No eGFR reported before, during, or after Ramadan |
| [35] | Retrospective study from Riyadh, KSA that included 499 patients admitted for AKI during Ramadan compared to 499 patients admitted for AKI during the following lunar month (Shawal) in 2016 and 2017. Ramadan Fasting was assumed | Incidence of AKI during Shawal was significantly higher than during Ramadan. HTN, a history of AKI, and cirrhosis were significant predictors. The higher incidence of AKI in Shawal may be the result of higher ambient temperatures during Shawal compared to Ramadan |
| [36] | Prospective study from Fez, Morocco on 60 CKD patients divided into three groups: | Seven patients (12%) developed AKI (one at Stage 1, five with Stage 2, and one with Stage 3). Five patients recovered completely and two recovered partially. A baseline Cr Cl <60 mL/min was the only risk factors identified. Mean baseline Cr Cl for all patients was 72.9 mL/min. No Cr Cl values during and after Ramadan were reported |
| Group 1: 29 patients with Cr Cl >60 mL/min |
| Group 2: 26 patients with Cr Cl = 30–59 mL/min |
| Group 3: 5 patients with Cr Cl = 15–29 mL/min |
| [37] | Prospective study from Konya, Turkey designed to determine the incidence of AKI during Ramadan fasting. The study included 45 fasting subjects with mean eGFR >80 mL/min/1.73 m2 | AKI Stage 2 was reported immediately before Iftar as per AKIN-urinary output criteria that was accompanied by a small but significant increase in mean creatinine that did not meet AKIN criteria (thirst period <48 hours long and creatinine increase <26.5 μmol/L) |
| [38] | Prospective study from Riyadh, KSA on 65 CKD-ND (Stage 3–5) patients with mean eGFR 31 mL/min. No eGFR data during or after Ramadan were provided | WKF developed in 34%. WKF developed during in 15 patients and after Ramadan in seven, including 7/36 with Stage 3, 12/24 with Stage 4, and 3/5 with Stage 5. Only eight patients improved. Risk factors included a lower baseline eGFR, higher baseline systolic BP, and younger age. Fasting had no apparent impact on potassium levels |
| [39] | Prospective study from Dammam, KSA that included 36 fasting CKD patients with Cr Cl <35 mL/min. Dates were not reported | Statistically significant deterioration in Cr Cl from pre-Ramadan average values of 17.2 ± 3.5 mL/min to immediate and two-week post-Ramadan average values of 13.2 ± 2.2 and 13.7 ± 3.2 mL/min, respectively |
| [40] | Prospective study from Alexandria, Egypt that included 12 CKD patients with a mean eGFR of 33 mL/min but no severe heart or liver disease. The control group included six healthy men | No significant changes in GFR were observed, although urinary NAG tended to rise in those with CKD signaling renal tubular injury. Significantly higher serum potassium levels were observed during Ramadan among those in the CKD group. No significant differences in BP were reported |
| GFR was measured with Tc-99m stannous DTPA renography before and during Ramadan |
| [41] | Prospective study from Al-Ain, UAE that included 31 patients with CKD-ND (Stages 3–5) with a mean Cr Cl of 29.7 mL/min determined by CG formula. Patients evaluated before, during the final week, and one month after Ramadan | Statistically significant improvements in eGFR during and after Ramadan (30.9 and 32.7 mL/min, respectively) accompanied by nonsignificant drop in BP and weight with no risk of hyperkalemia and no effect on PCR |
| [42] | Prospective study from Zagazig, Egypt that included 30 fasting patients with DM, 63% with a mean baseline ACR >30 | ACR increased significantly from a pre-Ramadan baseline mean of 98.41 ± 160.49 compared to a post-Ramadan mean of 141.49 ± 228.62. No eGFR values were reported |
| [43] | Prospective study from Istanbul, Turkey on 23 fasting (eGFR 86 mL/min/1.73 m2) versus 31 nonfasting (eGFR 66 mL/min/1.73 m2) PCKD patients | No significant changes in urine biomarkers (NGAL, KIM1), eGFR, potassium, weight, or 24-hour urine volume in either group. Significant reduction in proteinuria and insignificant reduction in BP were observed in the fasting group |
| [44] | Prospective study from Cairo, Egypt on 52 fasting CKD patients (eGFR 27.7 mL/min/1.73 m2) versus 54 nonfasting CKD patients (eGFR 21.5 mL/min/1.73 m2) | Higher risk of CV events in patients with preexisting CVD and an early increase in creatinine levels. Values for eGFR dropped during Ramadan with RAASi and diuretics. Creatinine levels were not significantly different from baseline when evaluated three months after Ramadan |
| [45] | A prospective study from Rize, Turkey that included 45 fasting CKD-ND (Stage 3–5) patients (42.6) versus 49 nonfasting CKD patients (31.9) | No significant changes in mean eGFR or BP before and after Ramadan were observed between groups, but a trend toward improved mean eGFR values among those in the fasting group. Four patients in each group developed WKF; these individuals were older and treated with diuretics |
| [46] | A prospective study from Corum, Turkey 2–7/Jun–5/Jul/2016 that included 24 fasting (eGFR 35 mL/min/1.73 m2) and 55 nonfasting (eGFR 34 mL/min/1.73 m2) CKD patients | No statistically significant differences between the groups were observed with respect to WKF (25% reduction in eGFR or 26.5 μmol/L rise in creatinine levels), which was reported in 12.5% of fasting versus 7.5% nonfasting CKD patients. DM and proteinuria were risk factors for WKF |
| [47] | A prospective study from London, UK that included 68 fasting (eGFR 47 mL/min/1.73 m2) and 71 nonfasting (eGFR 48 mL/min/1.73 m2) diabetic CKD patients | No significant changes in weight, BP, creatinine, and urinary PCR evaluated both pre- and post-Ramadan were observed either within or between the two groups. No episodes of AKIs were reported |
| [48] | A prospective study from Ordu, Turkey included 64 fasting (eGFR 46.2 mL/min/1.73 m2) and 66 nonfasting (eGFR 35.8 mL/min/1.73 m2) CKD-ND (Stages 3–5) patients | A small but statistically significant increase in eGFR was observed among those in the fasting group (to 48 mL/min/1.73 m2) and a corresponding decline (to 33 mL/min/1.73 m2) in the nonfasting group. No effects on ACR or serum potassium levels were reported |
| [49] | A prospective study from Dubai, UAE that included 19 fasting diabetic CKD patients with average baseline eGFRs of 48.9 mL/min/1.73 m2 | No significant changes in eGFR, weight, BP, or serum potassium levels were reported |
| [50] | Study from Mansoura, Egypt that included 20 fasting CKD patients with an average baseline eGFR of 25.7 mL/min/1.73 m2 | No significant changes in creatinine were reported. A nonsignificant rise in eGFR (to 28.3 mL/min/1.73 m2) was observed after Ramadan. No significant changes in weight, BMI, muscle and bone mass, total body water, or visceral fat were observed after Ramadan fasting |
| [51] | Prospective study from Hyderabad, India that included 28 fasting CKD patients | No significant differences in average eGFR for patients before and after Ramadan (56 versus 54.5 mL/min/1.73 m2). Four CKD 4 and 5 patients exhibited WKF. Two of these patients improved after Ramadan and two did not. Low eGFRs were identified as the only associated risk factor |
| [52] | Prospective study from Mansoura, Egypt divided 90 fasting type 2 DM patients into three groups: | Pre- to post-Ramadan values of ACR increased significantly (71 to 112 and 16 to 42) and eGFR decreased significantly (114 to 78 mL/min/1.73 m2 and 113 to 98 mL/min/1.73 m2) among those in Groups 2 and 3 |
| Group 1: ACR >30 and eGFR 60–<90 mL/min |
| Group 2: ACR >30 and eGFR >90 mL/min |
| Group 3: No CKD |
| [53] | Prospective study from Fayoum, Egypt that included 337 fasting patients with type 2 DM and a mean pre-Ramadan baseline creatinine levels of ≤88 μmol/L and ACR of ≤80 | A small but statistically significant increase in both mean Cr ≤95 μmol/L and mean ACR ≤90 after Ramadan was observed together with a statistically significant reduction in systolic BP |
| [54] | Prospective study from Singapore that included 68 fasting patients with type 2 DM with eGFR ≥45 mL/min. These patients were divided into groups based on SGLT2i use (yes/no). Patients’ mean eGFRs was 88 mL/min/1.73 m2 and 70% had an ACR >30 | Statistically significant reductions in weight, BP, and baseline eGFR were reported in both groups during Ramadan. Increases in serum potassium levels observed during Ramadan correlated with reductions in eGFR and not with RAASi use |
| [55] | Prospective, longitudinal study from Karachi, Pakistan that included 70 fasting patients with type 2 DM and mean baseline eGFRs of 75 mL/min. The number of patients with eGFRs <60 mL/min was unknown | The mean eGFR measured six weeks post-Ramadan was significantly reduced (to 63 mL/min/1.73 m2). However, 29 patients who presented with a mean baseline eGFR of 72 mL/min experienced no change in mean eGFR when evaluated 12 months later. Values for eGFR dropped equally in CKD and non-CKD patients |
| [56] | Prospective study from Marrakech, Morocco that included 39 patients with type 2 DM and baseline eGFRs of 130 mL/min; 87% of these patients presented with an ACR <30. It reported changes in mean eGFR and hydration status measured by bioelectrical impedance analysis (BIA) | Significant decline in eGFR to 117 mL/min accompanied by an increase in hydration measured by BIA from 34.7 to 35. Creatinine increased in 67% of patients. Small but significant reductions in BMI, but no comment on BP or ACR. Risk of AKI was significantly higher in patients with baseline eGFRs <60 mL/min/1.73 m2, although it is not clear how many of these patients were included in the study |
| [57] | Prospective study from Banha, Egypt that included 20 healthy subjects with normal Cr Cl (124 mL/min by CG formula) and ACRs of 13 compared to 20 type 2 DM patients (creatinine clearance of 107 mL/min and baseline ACR of 36) who were or were not treated with vitamin E | Significant increases in Cr Cl in the nondiabetic patients treated with vitamin E during Ramadan were observed together with insignificant reductions in ACR throughout. The precise creatinine clearance values were not provided |
| [58] | Prospective study from Riyadh, KSA that included 39 CKD-ND (Stage 3–5) patients with an average baseline Cr Cl of 40.8 mL/min | No significant changes in eGFR, urine volume, or proteinuria were observed |
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