{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:02:41Z","timestamp":1790906561760,"version":"4.1.0"},"reference-count":133,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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 and can 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 three main hormones: parathyroid hormone, fibroblast growth factor 23 and 1,25-dihydroxyvitaminD3. 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.<\/jats:p>","DOI":"10.1093\/ckj\/sfab078","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T20:27:10Z","timestamp":1618345630000},"page":"2304-2315","source":"Crossref","is-referenced-by-count":40,"title":["Hypophosphatemia in cancer patients"],"prefix":"10.1093","volume":"14","author":[{"given":"Shreedhar","family":"Adhikari","sequence":"first","affiliation":[{"name":"Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Mamlouk","sequence":"additional","affiliation":[{"name":"Section of Nephrology, University of Texas MD Anderson Cancer Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-146X","authenticated-orcid":false,"given":"Helbert","family":"Rondon-Berrios","sequence":"additional","affiliation":[{"name":"Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biruh T","family":"Workeneh","sequence":"additional","affiliation":[{"name":"Section of Nephrology, University of Texas MD Anderson Cancer Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,15]]},"reference":[{"key":"2021110804500817900_sfab078-B1","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s10147-016-1063-0","article-title":"Incidence of hypophosphatemia in advanced cancer patients: a recent report from a single institution","volume":"22","author":"Yoshida","year":"2017","journal-title":"Int J Clin Oncol"},{"key":"2021110804500817900_sfab078-B2","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1136\/bmj.1.5795.273","article-title":"Hypophosphataemia and hyperphosphataemia in a hospital population","volume":"1","author":"Betro","year":"1972","journal-title":"Br Med J"},{"key":"2021110804500817900_sfab078-B3","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1001\/archinte.1988.00380010155016","article-title":"Severe hypophosphatemia in hospitalized patients","volume":"148","author":"Halevy","year":"1988","journal-title":"Arch Intern Med"},{"key":"2021110804500817900_sfab078-B4","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1136\/jcp.2007.054940","article-title":"Hypophosphataemia at a large academic hospital in South Africa","volume":"61","author":"Hoffmann","year":"2008","journal-title":"J Clin Pathol"},{"key":"2021110804500817900_sfab078-B5","first-page":"67","article-title":"Severe hypophosphatemia in sepsis as a mortality predictor","volume":"36","author":"Shor","year":"2006","journal-title":"Ann Clin Lab Sci"},{"key":"2021110804500817900_sfab078-B6","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1007\/BF01700966","article-title":"High incidence of hypophosphatemia in surgical intensive care patients: efficacy of phosphorus therapy on myocardial function","volume":"21","author":"Zazzo","year":"1995","journal-title":"Intensive Care Med"},{"key":"2021110804500817900_sfab078-B7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00024382-200208000-00003","article-title":"Pathophysiologic and clinical correlates of hypophosphatemia and the relationship with sepsis and outcome in postoperative patients after hepatectomy","volume":"18","author":"Giovannini","year":"2002","journal-title":"Shock"},{"key":"2021110804500817900_sfab078-B8","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1001\/archsurg.1996.01430220037007","article-title":"Refeeding hypophosphatemia in critically ill patients in an intensive care unit. 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