ArticleBMC nephrology2026
Ramadan and Kidney Disease (RaK) risk assessment tool. Potential risk calculator for evaluating the risk of Ramadan fasting in chronic kidney disease patients.
Article in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFasting during Ramadan has been found safe for most chronic kidney disease (CKD) patients, but may pose risks for some. The Ramadan and Kidney Disease (RaK) working group has developed a risk stratification tool to categorize CKD patients who intend to fast into low-, moderate-, and high-risk groups. We propose a Ramadan fasting calculator that incorporates key risk factors to guide fasting decisions for CKD patients.
methodsA prospective cohort study was conducted at Ambulatory Healthcare Services from March 2024 to August 2024. The Electronic Medical Records (EMRs) of 220 patients were reviewed, supplemented by telephone interviews conducted before and after Ramadan. The primary outcomes assessed were the Ramadan fasting experience and the occurrence of adverse significant events (ASEs), which include hospital admissions.
resultsAmong the 220 participants, 71.4% completed all 30 days of fasting during Ramadan, 7.3% began fasting but had to break it, and 21.4% did not fast. This sample's mean and median RaK scores were 9.78 and 9.0, respectively; 55.5% had a score of 9 or lower, 24.5% had scores between 10 and 13, and 18.6% had scores above 13. A total of 39 adverse significant events (ASEs) were recorded. Using ordinal regression (proportional odds model) the RaK score was the only significant predictor of fasting (none, interrupted, complete), with an estimate of -0.159 (95% CI: -0.264 to -0.053), p = 0.003. The area under the curve (AUC) for predicting attempts at fasting (using logistic regression) was 0.715 (95% CI: 0.635-0.794), with an optimal cutoff of 9.5. Using logistic regression, a higher RaK score was significantly associated with an increased incidence of ASE (β = 0.253, OR = 1.287( 1.036-1.599, p = 0.023). Decision-curve analysis showed a positive net clinical benefit across threshold probabilities of 7-44%, identifying about 1 additional ASE patient per 10 evaluated patients and avoiding 1 unnecessary intervention per 7 patients compared with universal intervention at a 10% threshold.
conclusionThe RaK score demonstrated potential predictive value for fasting status and adverse events among CKD patients; however, validation in different populations is recommended.
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