Hypophosphatemia in cancer patients

Abstract

Dysregulation of phosphorus homeostasis resulting in hypophosphatemia is common in cancer patients and can result in serious complications and impact outcomes. Several factors, including critical illness, nutritional status, cancer type, and therapy, influence the development of hypophosphatemia. Hypophosphatemia can develop as a result of phosphaturic mesenchymal tumors or as a paraneoplastic phenomenon. The clinical presentation for hypophosphatemia varies depending on the duration and severity of the hypophosphatemia and affects several organ systems. Among other serious effects, hypophosphatemia can impair tissue oxygenation, cause hemolysis, leukocyte and platelet dysfunction, encephalopathy, seizures, arrhythmias, cardiomyopathy, rhabdomyolysis, and coma. Multiple studies have demonstrated that hypophosphatemia is an adverse prognostic marker in inpatients with increased in-hospital stay, mortality, and postoperative complications. The phosphate level is homeostatically regulated and maintained in a narrow range by 3 main hormones: PTH, FGF-23, and 1,25 (OH)2 Vitamin D3. Together, these hormones regulate how the intestine, kidneys, and bones traffic phosphorus. Several hematological malignancies and cancer therapies are associated with proximal tubular dysfunction (Fanconi syndrome), resulting in phosphaturia. Caution should be taken with parenteral administration of phosphate salts because secondary complications can develop principally due to hypocalcemia. The general approach to hypophosphatemia should target the underlying cause. Early recognition and prevention are essential, and the approach to hypophosphatemia in the cancer patient because of the nuances and complexity should be multidisciplinary.

A New Fe(III) Complex Derived from Cyclohexane Based Imine Derivative: Studies on H2PO4− Recognition and Anti‐Cancer Activity Against MCF7 and MDA‐MB‐231 Human Breast Cancer Cells

“…[3][4] However, unusual phosphate level in human body fluids, such as saliva, blood serum and urine are the biomarkers of physiological dysfunctions including cancer. [5,6] On the other hand, phosphates have detrimental effect on aquatic systems. Overdose of inorganic phosphate (> 0.1 mg L À 1 ) in agriculture lead to excess algal blooming in water bodies [7] that reduces dissolved oxygen level resulting eutrophication of aquatic systems, an alarming indicator of water pollution.…”

“…Hypophosphatemia is frequently found in cancer patients, which, if detected in early stages, can save lives of millions. [6] Increased rate of morbidity and mortality in cancer necessitate the design of multi-targeted drug to prevent cancer [19][20][21] which is really a challenging task. Interestingly, several bio-active metal complexes may destroy cancer cells through multiple dissimilar mechanism.…”

“…Moreover, it plays a distinctive role in several chemotherapeutic and antiviral drugs [3–4] . However, unusual phosphate level in human body fluids, such as saliva, blood serum and urine are the bio‐markers of physiological dysfunctions including cancer [5,6] . On the other hand, phosphates have detrimental effect on aquatic systems.…”

Anaplastic lymphoma kinase inhibitors and their effect on the kidney

“…In a review by Adhikari et al . [ 57 ], the authors attributed hypophosphatemia in patients treated with crizotinib to inhibition of the insulin (IGF-1) receptor located in the proximal tubules blocking the reabsorption of phosphate and thus producing phosphaturia.…”

Outcomes of patients with post-hepatectomy hypophosphatemia: A narrative review

“…However, HP may result in severe complications such as neuromuscular disturbances including encephalopathy, seizures, coma, pulmonary complications such as respiratory failure (in view of respiratory muscle weakness), cardiovascular complications such as impaired myocardial performance, hemolytic anemia, or even death[ 3 ]. Sequelae of patients with underlying malignancy such as nausea, vomiting and loss of appetite may result in HP from reduced dietary intake[ 4 ].…”