Hepatic surgery-related hypophosphatemia

Datta, Harish K.; Malik, M.; Neely, R. D. G.

doi:10.1016/j.cca.2007.01.027

Cited by 36 publications

(50 citation statements)

References 113 publications

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“…Phosphate homeostasis is complex, involving kidneys, gastrointestinal absorption, skeletal (29). Beyond liver resection, other common factors of post-operative management have been implicated in HP after surgery, including re-feeding syndrome, parenteral nutrition with low phosphate content, and use of glucose containing intravenous solutions (30)(31)(32). These factors were unlikely to be implicated in HP observed in this study.…”

Section: Discussionmentioning

confidence: 67%

“…Liver tissue contains 0.3% of phosphate by weight (17); therefore increased flux of serum phosphate into hepatocytes appears needed for high energy consuming liver regeneration process. Since it takes up to seven days before phosphate starts mobilizing from bones, such a high phosphate consuming process can account for large decreases in serum phosphate early after surgery (30). This hypothesis is supported by canine models subjected to sub-total hepatectomy that led to rapid uptake of radiolabeled phosphate and increased mitotic counts in the regenerating residual liver, resulting in HP (18,19).…”

Section: Discussionmentioning

confidence: 95%

“…Attributing post-hepatectomy HP to liver regeneration has been challenged by small studies identifying urinary waste with increased fractional urinary phosphate excretion paralleling the serum phosphate drop among 9 to 20 patients (35,36). The mechanism triggering hyperphosphaturia remains unclear, with processes such as action of phosphatins, or release of proteolytic enzymes by the damaged liver to activate phosphaturic hormones being proposed but not investigated yet (30).…”

Section: Discussionmentioning

confidence: 99%

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Hypophosphatemia and recovery of post-hepatectomy liver insufficiency

Hallet

Karanicolas

Zih

et al. 2016

Hepatobiliary Surg. Nutr.

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Recent major advancements in the technique and intraoperative management have significantly improved outcomes of hepatic surgery (1). However, post-operative liver failure remains a significant complication, responsible for 60% to 100% of deaths after liver resection (1-4).Considering the rising prevalence of parenchymal liver disease and the increased use of potentially hepatotoxic neoadjuvant chemotherapy, more patients are and will be at risk of post-hepatectomy liver failure (PHLF) (5,6).While initial liver insufficiency (ILI), whereby serum bilirubin and international normalized ratio (INR) rise in the first 24 to 72 hours following hepatectomy, is frequent, it is most often transient (7) 65.0%; P=0.03). Conclusions:In patients who experience post-hepatectomy ILI, HP is associated with improved recovery, potentially indicating more efficient liver regeneration. Further studies should explore the usefulness of posthepatectomy HP as an early prognostic factor of recovery from ILI.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Hypophosphatemia and recovery of post-hepatectomy liver insufficiency

Hallet

Karanicolas

Zih

et al. 2016

Hepatobiliary Surg. Nutr.

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“…[9][10][11] Acute hypophosphatemia causes septicemia and is associated with a poor prognosis. 11,12 Acute hypophosphatemia is of considerable clinical relevance because many hepatectomized patients develop marked hypophosphatemia and, thus, large doses of Pi replacement are required to maintain metabolic homeostasis. 13 Urinary Pi excretion is markedly increased in many patients.…”

mentioning

confidence: 99%

Hepatectomy-Related Hypophosphatemia

Nomura

Tatsumi

Miyagawa

et al. 2014

Journal of the American Society of Nephrology

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Marked hypophosphatemia is common after major hepatic resection, but the pathophysiologic mechanism remains unknown. We used a partial hepatectomy (PH) rat model to investigate the molecular basis of hypophosphatemia. PH rats exhibited hypophosphatemia and hyperphosphaturia. In renal and intestinal brush-border membrane vesicles isolated from PH rats, Na + -dependent phosphate (Pi) uptake decreased by 50%-60%. PH rats also exhibited significantly decreased levels of renal and intestinal Na + -dependent Pi transporter proteins (NaPi-IIa [NaPi-4], NaPi-IIb, and NaPi-IIc). Parathyroid hormone was elevated at 6 hours after PH. Hyperphosphaturia persisted, however, even after thyroparathyroidectomy in PH rats. Moreover, DNA microarray data revealed elevated levels of nicotinamide phosphoribosyltransferase (Nampt) mRNA in the kidney after PH, and Nampt protein levels and total NAD concentration increased significantly in the proximal tubules. PH rats also exhibited markedly increased levels of the Nampt substrate, urinary nicotinamide (NAM), and NAM catabolites. In vitro analyses using opossum kidney cells revealed that NAM alone did not affect endogenous NaPi-4 levels. However, in cells overexpressing Nampt, the addition of NAM led to a marked decrease in cell surface expression of NaPi-4 that was blocked by treatment with FK866, a specific Nampt inhibitor. Furthermore, FK866-treated mice showed elevated renal Pi reabsorption and hypophosphaturia. These findings indicate that hepatectomy-induced hypophosphatemia is due to abnormal NAM metabolism, including Nampt activation in renal proximal tubular cells.

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“…The pathophysiology of hypophosphatemia, the novel investigations and rational of administration has been evaluated Dutta and his colleagues. 22 Studies by Tan and colleagues do not endorse the routine administration of hyper alimentation with supra therapeutic phosphorus because of its potential morbidity. …”

Section: Discussionmentioning

confidence: 99%

Post hepatectomy hypophosphatemia and its association with initial liver insufficiency and morbidity

et al. 2018

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Background: Hypophosphatemia after liver resection is a frequent issue, only a small subset of patient requires correction. This group of patients associated with morbidity was evaluated.Methods: Liver resections were retrospectively analysed between Jan 2015 and March 2018. We evaluated the association of hypophosphatemia (defined as serum phosphate <2mg/dl) and the occurrence of initial liver insufficiency (ILI) [ Elevation of total bilirubin above 2mg/dl above the preoperative values and INR more than 1.7]. Any association of hypophosphatemia with post-operative major morbidity (Clavien Dind0 grade 3 and 4 complications) was also studied.Results: A total of 86 patients were analysed during the study period, 28 patients were excluded as per the exclusion criteria and 58 patients were included in the study. Majority of the patients in our study populations were above 60yrs of age with male preponderance. Hepatocellular carcinoma was the frequent indication for surgery. Significant hypophosphatemia was seen in 15 patients reaching nadir values on Post-operative day 3. Clavien Dindo Grade- 3,4 complications was seen in 7 patients and 8 patients had Initial liver insufficiency.Conclusions: This study tried to evaluate only the subset of patients who had significant hypophosphatemia who required replacement with initial liver insufficiency and morbidity. We have found association of hypophosphatemia with initial liver insufficiency and morbidity. Hence, authors advocate early identification and correction to avoid possible complications.

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Hepatic surgery-related hypophosphatemia

Cited by 36 publications

References 113 publications

Hypophosphatemia and recovery of post-hepatectomy liver insufficiency

Hypophosphatemia and recovery of post-hepatectomy liver insufficiency

Hepatectomy-Related Hypophosphatemia

Post hepatectomy hypophosphatemia and its association with initial liver insufficiency and morbidity

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