title: Pica: an important and unrecognized problem in pediatric dialysis patients.
abstract: OBJECTIVE
  Pica is the compulsive consumption of non-nutritive substances, and this disorder may occur more frequently in dialysis patients. The purpose of our study was to determine the prevalence of pica and the associated demographic and metabolic characteristics.
  
  
  METHODS
  Retrospective, cross-sectional analysis.
  
  
  METHODS
  Hospital-based, outpatient, pediatric hemodialysis unit.
  
  
  METHODS
  Eighty-seven pediatric patients on chronic dialysis therapy were interviewed. Sixty-seven patients were receiving hemodialysis, whereas the remaining 20 were maintained on peritoneal dialysis. The predominantly nonwhite (93%) patient population had a mean age of 17.2 ± 7.2 years. Dialysis efficiency, estimated by urea clearance per patient volume (Kt/V), averaged 1.5 ± 0.5.
  
  
  METHODS
  Standard patient interview and documentation of laboratory and dialytic parameters.
  
  
  METHODS
  Prevalence of pica and associated comorbid conditions.
  
  
  RESULTS
  The survey indicated that 46% of patients experienced pica, further divided into simple "ice" pica (34.5%) versus "hard" pica (12.6%). Hard pica included the consumption of chalk, starch, sugar, soap, sand, clay, Ajax cleanser, sponge, wood, and potting soil. Patients on hemodialysis were 8.3 times more likely to have hard pica compared with those on peritoneal dialysis. Greater than 5 years on dialysis was associated with a 3.2 odds ratio of having pica (P = .02). Anemia was the most significant morbid association, occurring at an odds ratio of 4.4 (P = .001) for all pica and 10.6 (P = .004) for hard pica.
  
  
  CONCLUSIONS
  Pica, therefore, is prevalent and potentially harmful, requiring further attention in the nutritional management of pediatric dialysis patients.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA. ckatsoufis@med.miami.edu
authors.forename: Chryso Pefkaros
authors.initials: CP
authors.lastname: Katsoufis
authors.forename: Myerly
authors.initials: M
authors.lastname: Kertis
authors.forename: Judith
authors.initials: J
authors.lastname: McCullough
authors.forename: Tanya
authors.initials: T
authors.lastname: Pereira
authors.forename: Wacharee
authors.initials: W
authors.lastname: Seeherunvong
authors.forename: Jayanthi
authors.initials: J
authors.lastname: Chandar
authors.forename: Gaston
authors.initials: G
authors.lastname: Zilleruelo
authors.forename: Carolyn
authors.initials: C
authors.lastname: Abitbol
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000453:epidemiology; D002648:Child; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D016017:Odds Ratio; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010842:Pica / Q000453:epidemiology*; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D014508:Urea / Q000378:metabolism; D055815:Young Adult
chemical_list: D014508:Urea