Asymptomatic Hyperphosphatemia in Healthy Young Men and Women: Potential Association with Electronic Nicotine Delivery Systems and Heated Tobacco Products

Abstract

BACKGROUND: Hyperphosphatemia is defined as fasting phosphorus levels higher than 1.45 mmol/L. Although it is often asymptomatic, it can cause adverse effects, including hypocalcemia, decreased calcitriol levels, secondary hyperparathyroidism, ectopic calcification, hemodynamic disorders, and increased morbidity and mortality. Therefore, it is crucial to promptly identify and treat the underlying causes of hyperphosphatemia. Hyperphosphatemia is typically associated with renal failure. Less common causes include hypoparathyroidism; burn injury; metabolic and respiratory acidosis; rhabdomyolysis; tumor lysis syndrome; acromegaly; and excessive intake of phosphorus from food or medication.

AIM: The study aimed to identify the possible causes of an asymptomatic increase in blood phosphorus levels in young healthy adults.

METHODS: Laboratory tests were performed in young healthy men and women aged 18 to 35 years.

RESULTS: Despite preserved renal function, asymptomatic hyperphosphatemia was diagnosed in 12 (9.9%) participants. A significant association was found between hyperphosphatemia and the use of electronic nicotine delivery systems and heated tobacco products (p = 0.0002).

CONCLUSION: More research is needed on the effects of electronic nicotine delivery systems and heated tobacco products on human health, especially calcium and phosphorus metabolism.

Keywords

phosphorus / hyperphosphatemia / electronic nicotine delivery systems / heated tobacco products

References

[1] Tsai SH, Kan WC, Jhen RN, et al. Secondary hyperparathyroidism in chronic kidney disease: a narrative review focus on therapeutic strategy. Clin Med (Lond). 2024;24(5):100238. doi: 10.1016/j.clinme.2024.100238

[2] Xu X, Zhang L, Liu W, et al. Analysis of the relationship between early serum phosphate levels and short-term mortality in septic patients: a retrospective study based on mimic-IV. Shock. 2023;59(6):838–845. doi: 10.1097/SHK.0000000000002119

[3] Clinical recommendations. Chronic kidney disease. 2021. [Internet]. Available from: https://rusnephrology.org/wp-content/uploads/2020/12/CKD_final.pdf Accessed: 19 Sept 2024). (In Russ.)

[4] Koumakis E, Cormier С, Roux C, Briot K. The causes of hypo- and hyperphosphatemia in humans. Calcif Tissue Int. 2021;108(1):41–73. doi: 10.1007/s00223-020-00664-9

[5] Leung J, Crook M. Disorders of phosphate metabolism. J Clin Pathol. 2019;72(11):741–747. doi: 10.1136/jclinpath-2018-205130

[6] Mohort TV. Disorders of phosphorus metabolism in clinical practice. Meditsinskie novosti. 2023;(4):28–34. (In Russ.)

[7] Volkov MM, Kayukov IG, Smirnov AV. Phosphorus-calcium metabolism and its regulation. Nephrology (Saint Petersburg). 2010;14(1):91–103. (In Russ.) doi: 10.24884/1561-6274-2010-14-1-91-103

[8] Anand A, Aoyagi H. Understudied hyperphosphatemia (chronic kidney disease). Treatment targets and new biological approaches. Medicina (Kaunas). 2023;59(5):959. doi: 10.3390/medicina59050959

[9] Boakye E, Obisesan OH, Osei AD, et al. The promise and peril of vaping. Curr Cardiol Rep. 2020;22(12):155. doi: 10.1007/s11886-020-01414-x

[10] Golan R, Muthigi A, Ghomeshi A, et al. Misconceptions of vaping among young adults. Cureus. 2023;15(4):e38202. doi: 10.7759/cureus.38202

[11] Virgili F, Nenna R, Ben David S, et al. E-cigarettes and youth: an unresolved Public Health concern. Ital J Pediatr. 2022;48(1):97. doi: 10.1186/s13052-022-01286-7

[12] Enikeyev DA, Idrisova LT, Enikeyev OA, et al. Comparison of hazard and toxicity of tobacco cigarettes, electronic nicotine delivery systems, and tobacco heating systems (iqos) (review). Patogenez. 2019;17(3):25–33. doi: 10.25557/2310-0435.2019.03.25-33

[13] Tsygan VN, editor. Clinical pathophysiology: a textbook for cadets and students of military medical universities. In 2 vol. Saint Petersburg: SpetsLit; 2018. Vol. 1: Pathophysiology. 430 p. (In Russ.)

[14] Litvitsky PF. Pathophysiology. Textbook. In 2 vol. 2nd edition. Moscow: GEOTAR-MED; 2003. Vol. 1. p. 421.

[15] Chagina EA, Turmova EP, Bashtovaya AE, Posadskaya MV. The pathogenetic role of phosphorus in the vital activity of the body. International Journal of Humanities and Natural Sciences. 2022;12(75):45–50. doi: 10.24412/2500-1000-2022-12-5-45-50

[16] Pankiv VI. Hyperparathyroidism: diagnostics, clinical signs and symptoms, modern approaches to treatment. International Endocrinology Journal. 2013;1(49):87–96. (In Russ.)

[17] Shutov EV, Sorokoletov SM. Hyperphosphatemia – meaning and methods of correction. Clinical nephrology. 2019;(2):69–75. (In Russ.) doi: 10.18565/nephrology.2019.2.69-75

RIGHTS & PERMISSIONS

Eco-Vector