Mineral disorders after hematopoietic stem cell transplantation in patients receiving parenteral nutrition

Background  Parenteral nutrition is a critical therapeutic approach for patients undergoing hematopoietic stem cell transplantation. However, parenteral nutrition is associated with complications such as mineral disorders. This study evaluated the prevalence of hypophosphatemia, hypokalemia, and hypomagnesemia in adult transplant patients before and within the first 24 days of parenteral nutrition infusion.

Patients and Methods  This retrospective cohort study included patients who underwent hematopoietic stem cell transplantation and required parenteral nutrition at a public quaternary hospital in Brazil between January 2012 and January 2022. Patients were categorized based on indications for parenteral nutrition and specific diagnoses. Laboratory monitoring of phosphorus, potassium, and magnesium levels was performed at predefined intervals during parenteral nutrition infusion, starting at 72 h and during subsequent 4-day intervals until engraftment. Hypophosphatemia, hypokalemia, and hypomagnesemia were defined as levels below established reference values. Descriptive analyses were applied, and the chi-square test, crude odds ratios, and Fisher's exact test were used to compare categorical variables between the periods.

Results  The study revealed varying prevalences of hypophosphatemia (21.1–40.3 %), hypokalemia (10.5–31.2 %), and hypomagnesemia (50.0–62.3 %) among the 77 patients included in the study. Severe mineral disorders were observed in only a small proportion of patients.

Conclusion  Patients undergoing hematopoietic stem cell transplantation had a high prevalence of mineral depletion throughout the engraftment period.

Keywords
Parenteral nutrition; Hematopoietic stem cell transplantation; Hypophosphatemia; Hypokalemia; Hypomagnesemia