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The prevalence of hypophosphatemia and refeeding-related hypophosphatemia in hospitalized patients requiring parental nutrition: a retrospective study

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Abstract

Objective

Hypophosphatemia might cause respiratory and heart failure and even death. We aimed to evaluate risk factors for hypophosphatemia and refeeding-related hypophosphatemia in patients requiring parental nutrition (PN).

Methods

This was a single-center, retrospective study. Clinical parameters were obtained from medical records. Serum phosphate (inorganic phosphorus) was measured by photometric analysis. Hypophosphatemia was confirmed when serum phosphate level was less than 0.8 mmol/L (≈2.5 mg/dl). Refeeding related hypophosphatemia was confirmed if serum phosphate level had a decrease of 0.16 mmol/L or more from baseline and if the final assessment was below 0.65 mmol/L.

Results

A total number of 655 (426 men and 229 women, aged 62.8 ± 14.8 years) hospitalized patients requiring PN were included in the study, and 60.6% of them were patients with cancer. The average body mass index (BMI) was 21.1 ± 4.1 kg/m2 and the median of serum phosphate was 0.9 mmol/L (quartile range: 0.68 mmol/L, 1.11 mmol/L). The prevalence of hypophosphatemia was 37.6% (246/655). Older age (≥ 65 years vs. < 65 years), lower serum level of pre-albumin (< 160 mg/L vs. ≥ 160 mg/L), calcium (< 2.11 mmol/L vs. ≥ 2.11 mmol/L), and magnesium (< 0.75 mmol/L vs. ≥ 0.75 mmol/L) were associated with high risk of hypophosphatemia by multivariate logistic regression (OR ranged from 1.43 to 3.06, all p < 0.05). Refeeding related hypophosphatemia was 9.5% (16/168). Serum level of calcium at baseline was significantly lower in participants with refeeding related hypophosphatemia than those without it. Total calorie and nitrogen delivered during first week of PN period showed no obvious difference between patients with and without refeeding related hypophosphatemia.

Conclusions

Hypophosphatemia is common (37.6%) in hospitalized patients requiring PN. Monitoring of serum level of phosphorus is necessary to facilitate early treatment of hypophosphatemia.

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Data availability

The SAS code and data that support the findings of this study are available from the first author upon reasonable request (Renying Xu, email address: 721001735@shsmu.edu.cn).

Abbreviations

BMI:

Body mass index

CI::

Confidence interval

CRRT:

Continuous renal replacement therapy

CV:

Coefficient of variance

DNA:

Deoxyribonucleic acid

EDTA:

Ethylene diamine tetraacetic acid

eGFR:

Estimated glomerular filtration rate

ICU:

Intensive care unit

OR:

Odd ratio

PN:

Parenteral nutrition

RNA:

Ribonucleic acid

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Author notes

  1. Yong-bing Qian and Ren-ying Xu contributed equally.

Authors and Affiliations

  1. Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Yi-quan Zhou, **ao-min Zhang, Zhi-qi Chen, Jia-lu Wang & Ren-ying Xu

  2. Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Yong-bing Qian

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  1. Yi-quan Zhou
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  2. **ao-min Zhang
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Contributions

Z-YQ and Z-XM equally contributed to the conception and design of the researched, and data analysis, and manuscript draft; C-ZQ and W-JL contributed to the collection and interpretation of data; Q-YB and X-RY reviewed/edited the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

Corresponding authors

Correspondence to Yong-bing Qian or Ren-ying Xu.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the Ethical Committee of Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University. As a retrospective study, patients’ consent was waived by the Ethical Committee of Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University. All methods were carried out in accordance with relevant guidelines and regulations in the declaration section under the ethics approval and consent to participate.

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Written informed consent for publication was obtained.

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The authors declare no competing interests.

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Zhou, Yq., Zhang, Xm., Chen, Zq. et al. The prevalence of hypophosphatemia and refeeding-related hypophosphatemia in hospitalized patients requiring parental nutrition: a retrospective study. Support Care Cancer 30, 6995–7003 (2022). https://doi.org/10.1007/s00520-022-07141-z

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  • DOI: https://doi.org/10.1007/s00520-022-07141-z

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