Abstract: SA-PO681
Resolution of Pica with Kidney Transplant
Session Information
- Pediatric Nephrology - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Vegh, Nicole, LSU Health New Orleans, New Orleans, Louisiana, United States
- Aviles, Diego H., LSU Health New Orleans, New Orleans, Louisiana, United States
Introduction
Pica, compulsive consumption of non-nutritive substances, has been documented in end stage renal disease (ESRD) requiring dialysis with a prevalence of 38-42% in adults and 46% in pediatric patients. Pica is often thought to be secondary to iron deficiency (ID), which is common in ESRD, however, it is debated if the ID drives the compulsion or the compulsion results in ID through impaired absorption of iron. Majority of patients who experience pica endorsed ice pica; hard pica is the ingestion of other substances aside from ice that can result in significant health consequences including death. A prior study in pediatric dialysis patients showed that the presence of anemia and dialysis duration >5 years was associated with increased odds ratio of pica and showed no statistical difference between hemodialysis (HD) vs peritoneal dialysis (PD) modalities or Kt/V between those with pica and those without. They also suggested an underlying cultural or stressful state of ESRD as risk factors for pica (Katsoufis et al,2012).
Case Description
We present an African American male with ESRD secondary to focal segmental glomerulonephritis (FSGS) on PD for approximately 5.5 years with pica ingestion, most frequently laundry detergent and carpet cleaner. He developed profound and persistent metabolic alkalosis which led to the discovery of pica. Despite maintaining adequate hemoglobin, iron stores and treatment for depression, his pica persisted. He developed pica near the onset of his kidney disease and 5 years before the initiation of dialysis. Pica resolved immediately following kidney transplantation.
Discussion
This case highlights the need for further evaluation of underlying causes of pica in patients not only in ESRD but also those with chronic kidney disease. Though previous studies have not demonstrated an association between decreased Kt/V and increased risk of pica, this case makes an argument for further investigation. The onset of his symptoms at the time of decreasing GFR, and resolution of symptoms with transplant and normalization of eGFR suggests significant renal insufficiency as a risk factor for pica. Kt/V is not a one-size fits all. Does the onset of pica symptoms suggest a need for improved clearance and a more personalized dialysis prescription?