Hukum Puasa Pesakit Dialisis: Hemodialisis & Dialisis PeritonealFasting Rulings for Dialysis Patients: Haemodialysis & Peritoneal Dialysis

Bagi ramai pesakit buah pinggang, Ramadan membawa satu persoalan yang berat: adakah rawatan dialisis membatalkan puasa? Jawapannya bukan satu — ia bergantung kepada jenis dialisis yang dijalani. Menurut eBook "Panduan Prosedur Ramadan 2024" terbitan Jabatan Pematuhan Syariah & Majlis Penasihat Syariah Hospital Pakar An-Nur, hemodialisis dan dialisis peritoneal mempunyai hukum yang berbeza. Artikel ini menjelaskan kedua-duanya, beserta rukhsah (keringanan) dan cara menggantikannya melalui qada' atau fidyah. For many kidney patients, Ramadan brings a weighty question: does dialysis treatment invalidate the fast? The answer is not a single one — it depends on the type of dialysis undergone. According to the "Ramadan Procedure Guide 2024" eBook by the Shariah Compliance Department & Shariah Advisory Council of An-Nur Specialist Hospital, haemodialysis and peritoneal dialysis carry different rulings. This article explains both, along with the concession (rukhsah) and how to make it up through qada' or fidyah.

1. Apa Itu Dialisis & Kenapa Hukumnya Dibincangkan1. What Dialysis Is & Why Its Ruling Is Discussed

Dialisis ialah proses membersihkan darah secara buatan untuk menggantikan fungsi buah pinggang yang gagal. Apabila buah pinggang tidak lagi mampu menapis toksik dan membuang lebihan air, pesakit bergantung pada mesin atau kaedah tertentu untuk terus hidup. Terdapat dua kaedah utama — dan inilah yang membezakan hukum puasanya: Dialysis is the artificial cleansing of the blood to replace the function of failed kidneys. When the kidneys can no longer filter toxins and remove excess fluid, the patient depends on a machine or a particular method to stay alive. There are two main methods — and it is precisely this that distinguishes their fasting rulings:

Persoalan fiqh timbul kerana puasa boleh terbatal apabila sesuatu masuk ke dalam rongga terbuka badan (jauf), atau apabila sesuatu itu menyerupai maksud memberi makan dan minum. Oleh sebab kedua-dua kaedah dialisis di atas berbeza — hemodialisis mengeluarkan darah untuk ditapis, manakala dialisis peritoneal memasukkan cecair ke dalam badan — maka hukum puasanya juga tidak sama. Mari kita teliti satu persatu mengikut pandangan Jabatan Pematuhan Syariah Hospital Pakar An-Nur, berpandukan eBook "Panduan Prosedur Ramadan 2024". The fiqh question arises because a fast can be broken when something enters an open bodily cavity (jawf), or when it resembles the intent of providing food and drink. Because the two dialysis methods above differ — haemodialysis removes blood to be filtered, whereas peritoneal dialysis introduces fluid into the body — their fasting rulings also differ. Let us examine each in turn according to the position of the Shariah Compliance Department of An-Nur Specialist Hospital, guided by the "Ramadan Procedure Guide 2024" eBook.

2. Hemodialisis — Pandangan An-Nur: Tidak Membatalkan Puasa2. Haemodialysis — An-Nur's View: Does NOT Invalidate the Fast

Dalam hemodialisis, darah pesakit dikeluarkan melalui satu tiub, ditapis oleh mesin dialisis (dialyzer) di luar badan untuk membuang toksik dan lebihan air, kemudian darah yang telah bersih itu dimasukkan semula ke dalam badan. Proses ini pada asasnya hanya mengeluar – membersih – memasukkan semula darah, tanpa memasukkan sebarang makanan atau minuman ke dalam rongga badan. Jadual di bawah meringkaskan pandangan tiga pihak mengikut eBook "Panduan Prosedur Ramadan 2024" An-Nur: In haemodialysis, the patient's blood is drawn out through a tube, filtered by a dialysis machine (the dialyzer) outside the body to remove toxins and excess fluid, and the cleaned blood is then returned to the body. In essence the process only removes – cleans – returns the blood, without introducing any food or drink into a bodily cavity. The table below summarises the views of three authorities per An-Nur's "Ramadan Procedure Guide 2024" eBook:

Petunjuk jadual: BR = tidak membatalkan puasa (puasa kekal sah); R = batal (membatalkan puasa) mengikut pandangan Majma' Fiqh Islami; M = membatalkan puasa. Table key: BR = does not invalidate the fast (the fast remains valid); R = broken (invalidates the fast) per Majma' al-Fiqh al-Islami; M = invalidates the fast.

Ringkasnya, kerana darah hanya dikeluar, dibersih, kemudian dimasukkan semula tanpa memasukkan makanan atau minuman, hemodialisis tidak menyerupai makan atau minum — maka ia tidak membatalkan puasa. Inilah pandangan Jabatan Pematuhan Syariah An-Nur, selari dengan keputusan JAKIM (2013). Namun perhatikan satu pengecualian penting: sekiranya ada unsur luar seperti nutrisi (contohnya glukos atau larutan pemakanan) dimasukkan ke dalam badan semasa sesi dialisis, ia boleh membatalkan puasa. Sebahagian ulama, seperti Majma' Fiqh Islami, berpendapat hemodialisis membatalkan puasa (kod R) atas dasar berhati-hati. Bagi pesakit yang mengambil pandangan tersebut, atau yang menerima nutrisi semasa rawatan, rukhsah dan gantiannya dijelaskan di Bahagian 4. In short, because the blood is only removed, cleaned, then returned without introducing food or drink, haemodialysis does not resemble eating or drinking — so it does not invalidate the fast. This is the position of An-Nur's Shariah Compliance Department, in line with JAKIM's ruling (2013). Note one important exception, however: if an external element such as nutrition (e.g. glucose or a feeding solution) is introduced into the body during the dialysis session, it may break the fast. Some scholars, such as Majma' al-Fiqh al-Islami, hold that haemodialysis does break the fast (code R) out of caution. For patients who follow that view, or who receive nutrition during treatment, the concession and its replacement are explained in Section 4.

3. Dialisis Peritoneal — Pandangan An-Nur: Membatalkan Puasa3. Peritoneal Dialysis — An-Nur's View: Invalidates the Fast

Dialisis peritoneal berbeza sama sekali daripada hemodialisis. Dalam kaedah ini, cecair dialisat dimasukkan ke dalam rongga peritoneal (rongga di dalam abdomen/perut) melalui satu kateter. Cecair itu dibiarkan seketika untuk menyerap toksik dan lebihan air daripada salur darah, kemudian dialirkan keluar. Oleh sebab ada bahan (cecair) yang dimasukkan ke dalam rongga badan, hukumnya tidak sama dengan hemodialisis: Peritoneal dialysis is entirely different from haemodialysis. In this method, dialysate fluid is introduced into the peritoneal cavity (the cavity within the abdomen) through a catheter. The fluid is left for a while to absorb toxins and excess fluid from the blood vessels, then drained out. Because a substance (fluid) is introduced into a bodily cavity, its ruling differs from haemodialysis:

Kerana cecair dialisat yang dimasukkan itu menyerupai maksud memberi kesan makan kepada badan (memasukkan bahan ke dalam jauf), maka dialisis peritoneal membatalkan puasa. Inilah pandangan Jabatan Pematuhan Syariah An-Nur, dan ia turut disokong oleh Majma' Fiqh Islami (kod M). JAKIM pula meletakkannya sebagai tidak membatalkan (kod BR), namun An-Nur mengambil pandangan yang lebih berhati-hati memandangkan jelas ada bahan dimasukkan ke dalam rongga badan. Oleh itu, pesakit dialisis peritoneal dinasihatkan mengambil rukhsah — keringanan untuk tidak berpuasa pada hari rawatan — dan menggantikannya kemudian, sebagaimana dijelaskan di bahagian seterusnya. Because the introduced dialysate resembles the intent of giving the effect of food to the body (introducing a substance into the jawf), peritoneal dialysis invalidates the fast. This is the position of An-Nur's Shariah Compliance Department, and it is likewise supported by Majma' al-Fiqh al-Islami (code M). JAKIM classifies it as not breaking the fast (code BR); however, An-Nur takes the more cautious view given that a substance is clearly introduced into a bodily cavity. Accordingly, peritoneal dialysis patients are advised to take the concession (rukhsah) — the leave not to fast on treatment days — and to make it up later, as explained in the next section.

4. Rukhsah & Gantian: Qada' atau Fidyah4. Concession & Replacement: Qada' or Fidyah

Sekiranya pesakit tidak mampu meneruskan puasa — sama ada kerana menjalani dialisis peritoneal, menerima nutrisi semasa hemodialisis, atau kerana rawatan itu terlalu memberatkan tubuh yang sakit — Islam memberikan rukhsah (keringanan) untuk tidak berpuasa pada hari rawatan. Ini bukan satu dosa; malah ia adalah rahmat dan kemudahan daripada Allah SWT bagi orang yang sakit. Namun keringanan itu datang dengan tanggungjawab menggantikannya, sama ada melalui qada' atau fidyah. If a patient is unable to continue fasting — whether because of undergoing peritoneal dialysis, receiving nutrition during haemodialysis, or because the treatment is too burdensome for an ill body — Islam grants a concession (rukhsah) not to fast on treatment days. This is not a sin; rather it is a mercy and an ease from Allah SWT for the one who is ill. Yet the concession comes with the responsibility to replace it, either through qada' or fidyah.

Keringanan ini bersandarkan firman Allah SWT dalam Surah Al-Baqarah, yang menetapkan bahawa orang sakit dan musafir yang tidak berpuasa hendaklah menggantikannya pada hari-hari lain (qada'), sambil menegaskan bahawa Allah menghendaki kemudahan, bukan kesukaran: This concession rests on the words of Allah SWT in Surah Al-Baqarah, which stipulate that the sick and the traveller who do not fast should make it up on other days (qada'), while affirming that Allah intends ease, not hardship, for you:

Qada' (ganti puasa): Jika pesakit mampu berpuasa pada hari-hari lain di luar Ramadan — contohnya pada hari yang tiada sesi dialisis, atau setelah keadaan kesihatannya stabil — maka dia wajib menggantikan setiap hari puasa yang ditinggalkan dengan berpuasa pada hari yang lain. Bilangan hari qada' adalah sama dengan bilangan hari yang ditinggalkan. Qada' (making up the fast): If the patient is able to fast on other days outside Ramadan — for instance on a day with no dialysis session, or once their health has stabilised — then they are obliged to make up each missed fasting day by fasting on another day. The number of qada' days equals the number of days missed.

Fidyah (bayaran ganti): Sebaliknya, jika pesakit tidak lagi mampu berpuasa langsung — seperti pesakit buah pinggang tahap akhir yang bergantung kepada dialisis secara berterusan dan uzur berpanjangan tanpa harapan untuk berpuasa semula — maka dia tidak dituntut qada', sebaliknya membayar fidyah bagi setiap hari yang ditinggalkan. Fidyah ialah memberi makan seorang miskin (secupak makanan asasi) bagi setiap hari puasa yang tidak dapat diganti. Ini disandarkan kepada firman Allah SWT: Fidyah (compensatory payment): Conversely, if the patient is no longer able to fast at all — such as an end-stage kidney patient who depends on continuous dialysis and is chronically incapacitated with no prospect of fasting again — then they are not required to make up the fast, but instead pay fidyah for each day missed. Fidyah is to feed a poor person (a measure of staple food) for each fasting day that cannot be replaced. This rests on the words of Allah SWT:

Perlu diingat, penentuan sama ada seseorang pesakit wajib qada' atau memadai dengan fidyah bergantung kepada keadaan kesihatannya yang sebenar — dan ini memerlukan penilaian doktor pakar serta rujukan kepada pihak berautoriti syarak. Kadar dan cara pembayaran fidyah juga berbeza mengikut ketetapan pihak berkuasa agama negeri. Justeru, bagi kes individu, berbincanglah dengan doktor yang merawat untuk menilai kemampuan tubuh, dan rujuk Jabatan/Pejabat Agama atau ustaz bertauliah untuk pengesahan hukum serta kadar fidyah. Bear in mind that determining whether a patient must perform qada' or may suffice with fidyah depends on their actual state of health — and this requires assessment by a specialist doctor together with reference to a competent Shariah authority. The rate and manner of paying fidyah also vary according to each state's religious authority. Therefore, for individual cases, discuss with the treating doctor to gauge the body's capacity, and refer to the Religious Department/Office or a qualified religious scholar to confirm the ruling and the fidyah rate.

Secara ringkas: hemodialisis tidak membatalkan puasa (selagi tiada nutrisi dimasukkan ke badan), maka pesakit boleh terus berpuasa jika mampu; manakala dialisis peritoneal membatalkan puasa, maka pesakit ambil rukhsah dan gantikan dengan qada' jika mampu, atau fidyah jika benar-benar tidak berdaya. Hukum dialisis ini adalah sebahagian daripada perbincangan lebih luas mengenai prosedur perubatan ketika berpuasa — baca panduan induk kami: Puasa Pesakit: Hukum Prosedur Perubatan & Ubat Ketika Ramadan. In brief: haemodialysis does not invalidate the fast (as long as no nutrition is introduced into the body), so a patient may keep fasting if able; whereas peritoneal dialysis invalidates the fast, so the patient takes the concession and replaces it with qada' if able, or fidyah if truly incapable. This dialysis ruling is part of a broader discussion of medical procedures while fasting — read our pillar guide: Fasting for Patients: Rulings on Medical Procedures & Medication in Ramadan.

5. Penjagaan Pesakit Buah Pinggang di An-Nur5. Kidney Patient Care at An-Nur

Hospital Pakar An-Nur ialah hospital pakar patuh syariah pertama di Malaysia. Bagi kami, kesihatan buah pinggang dan ketenangan beribadah berjalan seiring. Kami mempunyai unit hemodialisis sendiri serta Pakar Perunding Nefrologi (pakar buah pinggang) yang menjaga pesakit dalam persekitaran mesra ibadah — memudahkan pesakit menunaikan solat, memahami hukum puasa mereka, dan mendapat rawatan tanpa rasa was-was terhadap agama. An-Nur Specialist Hospital is Malaysia's first Shariah-compliant specialist hospital. For us, kidney health and peace in worship go hand in hand. We have our own haemodialysis unit and Consultant Nephrologists (kidney specialists) who care for patients in a worship-friendly environment — making it easier for patients to pray, understand their fasting ruling, and receive treatment without religious unease.

Jika anda atau ahli keluarga memerlukan rawatan buah pinggang, terokai perkhidmatan hemodialisis An-Nur dan berjumpa Pakar Nefrologi kami. Ingin memahami keadaan buah pinggang anda dengan lebih lanjut? Baca tanda-tanda buah pinggang rosak yang ramai tak perasan, dan pelajari pelan diet buah pinggang Stage 3 untuk melambatkan dialisis. If you or a family member needs kidney care, explore An-Nur's haemodialysis services and see our Nephrologist. Want to understand your kidney condition better? Read the signs of kidney damage many people miss, and learn about a Stage 3 kidney diet plan to delay dialysis.

Soalan Lazim (FAQ)Frequently Asked Questions (FAQ)

Baca SeterusnyaRead Next

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• Perkhidmatan Hemodialisis Hospital Pakar An-NurHaemodialysis Services at An-Nur Specialist Hospital
• Tanda Buah Pinggang Rosak Yang Ramai Tak PerasanSigns of Kidney Damage Many People Miss
• Diet Buah Pinggang Stage 3: Elak / Lambatkan DialisisStage 3 Kidney Diet: Avoid / Delay Dialysis
• Panduan Solat bagi Pesakit DialisisPrayer Guide for Dialysis Patients