Article Text

Download PDFPDF

Impact of Ramadan fasting on kidney function and related outcomes in patients with chronic kidney disease: a systematic review protocol
  1. Aminu K Bello,
  2. Julia Kurzawa,
  3. Mohamed A Osman,
  4. Michelle E Olah,
  5. Anita Lloyd,
  6. Natasha Wiebe,
  7. Syed Habib,
  8. Uwais Qarni,
  9. Soroush Shojai,
  10. Robert P Pauly
  1. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Robert P Pauly; rpauly{at}


Introduction Fasting during the month of Ramadan is a significant Islamic religious practice that involves abstinence from food, drink and medication from dawn to dusk. As just under a quarter of the world’s population identifies as Muslim, the effect of fasting on chronic conditions, such as chronic kidney disease (CKD) is a topic of broad relevance. To date, the information in this area has been mixed, with many limitations of previous studies. This study aims to synthesise the evidence of the effect of Ramadan fasting on changes on kidney function, risk factors, episodes of acute kidney injury and impact on the quality of life in patients with CKD or kidney transplant.

Methods and analysis A systematic review of the literature will be conducted, using electronic databases such as MEDLINE, Embase, Global Health, CINAHL and Scopus. Original research and grey literature on the effect of Ramadan fasting in adult patients with CKD or renal transplantation will be included. Two reviewers will independently screen articles for inclusion in the review and independently assess the methodology of included studies using a customised checklist. Mean difference or risk ratio will be reported for continuous or dichotomous outcomes and results will be pooled using a random-effects model where heterogeneity is reasonable. If possible, subgroups (CKD status, setting, season and risk of bias) will be analysed for effect modification with fasting and the outcomes of interest. Risk of bias will be assessed using the Downs and Black checklist.

Ethics and dissemination The results will be disseminated using a multifaceted approach to engage all stakeholders (patients, practitioners and community leaders). Research ethics board approval is not required as this is a systematic review of previously published research.

PROSPERO registration number CRD42018088973.

  • epidemiology
  • nephrology
  • renal transplantation
  • chronic renal failure

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors RPP, AKB, SH: conceived the original idea for this study. AKB, JK, MAO, AL and RPP: wrote the first draft of the manuscript. MEO, NW, UQ and SS: contributed to the study protocol development, reviewed the manuscript for intellectual content and approved the final submitted version of the manuscript.

  • Funding This work is funded by a grant from Northern Alberta Renal Program.

  • Competing interests None declared.

  • Ethics approval Approval by research ethics board is not required since the review will only include published and publicly accessible data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.