pica and Kidney-Diseases

Topics: Adult; Blood Chemical Analysis; Chlorobenzenes; Humans; Insecticides; Kidney Diseases; Leukoencephalopathies; Magnetic Resonance Imaging; Male; Neurologic Examination; New York City; Pica; Poison Control Centers; Substance-Related Disorders; Xenobiotics

Clay pica is a form of compulsive ingestion of non-nutritive substances frequently practiced by dialysis patients. Its consequences are unknown. In this study, we evaluated the effect of regular consumption of clay on hematologic and metabolic profiles in hemodialysis patients.. A prospective, case-control study with use of structured questionnaire.. Free-standing hemodialysis units.. One hundred thirty-eight patients on hemodialysis for at least 12 months were interviewed. Thirteen of 138 (9.4%) confessed to clay pica. Ten randomly selected patients with no history of pica served as control.. Average of all laboratory profiles and interdialytic weight gain (IDWG) over a 3-month period were recorded. Assay of the aluminum (Al), silica (Si), and iron (Fe) content of commercially purchased clay was performed.. Comparison of laboratory profiles and IDWG between cases and control. Estimation of the daily consumption of Al, Fe, and Si from clay and their relationship to the laboratory profiles.. There was no statistically significant difference in the levels of Al, albumin, calcium, ferritin, hematocrit, iron saturation, phosphorus, and IDWG between pica cases and control. Iron was significantly higher in pica patients (13.0 +/- 7.9 micromol/L v 7.5 +/- 2.5 micromol/L, P =.04), but potassium was higher among control than pica cases (4.9 +/- 0.7 mmol/L v 4.4 +/- 0.6 mmol/L, P =.07). Estimated metal exposure from daily clay consumption per patient were: Al (1-2 mg), Fe (11-23.5 mg), and Si (2-4.5 g). Multivariate logistic regression analysis failed to show any association between clay consumption and nutrition, anemia, or mineral metabolism (R(2) = 0.0, P =.79).. Clay pica does not appear to be detrimental to the hematologic and metabolic milieu of hemodialysis patients. The practice should, however, be discouraged, because of potential for ingestion of unknown substances, and reported potential for gastrointestinal complications.

Topics: Adult; Aged; Aluminum; Aluminum Silicates; Case-Control Studies; Clay; Female; Humans; Iron; Kidney Diseases; Logistic Models; Male; Middle Aged; Minerals; Pica; Potassium; Prospective Studies; Renal Dialysis; Silicon Dioxide; Surveys and Questionnaires

In a prospective study, pica behavior was investigated during baseline interviews with a cohort of incident patients (n = 226) who began chronic dialysis therapy in metropolitan Atlanta, GA, during 1996 to 1997. Pica, defined as current pica behavior and/or reported history of pica behavior, was reported by 16% of the sample. Patients reporting pica were significantly more likely to be African American women and were significantly younger than the remainder of the sample. Approximately two thirds of patients who reported pica behaviors craved and excessively consumed ice; the remainder craved and consumed starch, dirt, flour, or aspirin. Among patients reporting pica, average serum albumin values were low and average phosphorus was increased. The average hematocrit of patients reporting ice pica was low. Over half of the hemodialysis patients reporting pica behavior had excessive usual interdialytic weight gain. Potential symptoms/problems affecting quality of life among patients practicing pica, eg, cramps, are shown in a case report. The data indicate the need for targeted education and support for dietitians' increased interaction with dialysis patients involved in pica behaviors.

Topics: Adult; Aged; Black People; Body Mass Index; Female; Hematocrit; Humans; Kidney Diseases; Male; Middle Aged; Nutritional Status; Obesity; Peritoneal Dialysis; Phosphorus; Pica; Prospective Studies; Renal Dialysis; Serum Albumin; Sex Characteristics; Soil

Topics: Administration, Oral; Anemia, Hypochromic; Anemia, Macrocytic; Blood Transfusion; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Humans; Injections, Intramuscular; Iron; Kidney Diseases; Pica; Pregnancy; Pregnancy Complications, Hematologic