Ramadan Fasting in Kidney Transplant Recipients: A Narrative Review of Safety, Challenges, Management Strategies, and the Emerging Role of Artificial Intelligence

Abstract Ramadan, involves a daily fast from dawn to sunset. Religious observance is a significant consideration for many patients, including an estimated thousands of Muslim kidney transplant recipients (KTRs). The choice to fast involves a nuanced interaction of belief, personal values, and medical counsel. This review synthesizes the existing information about the safety and implications of Ramadan fasting for KTRs. It examines physiological challenges, including dehydration and potential nephrotoxicity; the crucial issue of modifying immunosuppressant dosing regimens; and the intricate religious considerations and ethical dilemmas encountered by patients and health care providers. Additionally, we explore the potential role of artificial intelligence in customizing risk evaluation, enhancing drug compliance, and delivering clinical decision support. We conclude that, although fasting entails risks, it may be appropriate for a select cohort of stable, long-term KTRs under stringent medical supervision. A multidisciplinary approach is essential to support patients in this spiritual practice safely.