Choice of High-Dose Intravenous Iron Preparation Determines Hypophosphatemia Risk
BACKGROUND: Ferric carboxymaltose (FCM) and iron isomaltoside 1000 (IIM) are increasingly used because they allow correction of severe iron deficiency in a single infusion. A transient decrease in serum phosphate concentrations is a frequent side effect of FCM.
AIM: To characterize this adverse event and search for its predictors in a gastroenterology clinic patient cohort.
METHODS: Electronic medical records of patients attending the University Hospital of Innsbruck were searched for the keywords ferric carboxymaltose or iron isomaltoside. Eighty-one patients with documented administration of FCM or IIM with plasma phosphate concentrations before and after treatment were included.
RESULTS: The prevalence of hypophosphatemia (<0.8 mmol/L) increased from 11% to 32.1% after treatment with i.v. iron. The hypophosphatemia risk was greater after FCM (45.5%) compared with IIM (4%). Severe hypophosphatemia (<0.6 mmol/L) occurred exclusively after FCM (32.7%). The odds for hypophosphatemia after i.v. iron treatment were independently determined by baseline phosphate and the choice of i.v. iron preparation (FCM vs. IIM-OR = 20.8; 95% CI, 2.6-166; p = 0.004). The median time with hypophosphatemia was 41 days, but prolonged hypophosphatemia of ≥ 2 months was documented in 13 of 17 patients in whom follow-up was available. A significant increase in the phosphaturic hormone intact FGF-23 in hypophosphatemic patients shows that this adverse event is caused by FCM-induced hormone dysregulation.
CONCLUSION: Treatment with FCM is associated with a high risk of developing severe and prolonged hypophosphatemia and should therefore be monitored. Hypophosphatemia risk appears to be substantially lower with IIM.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
PloS one - 11(2016), 12 vom: 02., Seite e0167146 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Schaefer, Benedikt [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 29.06.2017 Date Revised 04.12.2021 published: Electronic-eCollection Citation Status MEDLINE |
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| doi: |
10.1371/journal.pone.0167146 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM26672924X |
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| 100 | 1 | |a Schaefer, Benedikt |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Choice of High-Dose Intravenous Iron Preparation Determines Hypophosphatemia Risk |
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| 500 | |a Date Revised 04.12.2021 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Ferric carboxymaltose (FCM) and iron isomaltoside 1000 (IIM) are increasingly used because they allow correction of severe iron deficiency in a single infusion. A transient decrease in serum phosphate concentrations is a frequent side effect of FCM | ||
| 520 | |a AIM: To characterize this adverse event and search for its predictors in a gastroenterology clinic patient cohort | ||
| 520 | |a METHODS: Electronic medical records of patients attending the University Hospital of Innsbruck were searched for the keywords ferric carboxymaltose or iron isomaltoside. Eighty-one patients with documented administration of FCM or IIM with plasma phosphate concentrations before and after treatment were included | ||
| 520 | |a RESULTS: The prevalence of hypophosphatemia (<0.8 mmol/L) increased from 11% to 32.1% after treatment with i.v. iron. The hypophosphatemia risk was greater after FCM (45.5%) compared with IIM (4%). Severe hypophosphatemia (<0.6 mmol/L) occurred exclusively after FCM (32.7%). The odds for hypophosphatemia after i.v. iron treatment were independently determined by baseline phosphate and the choice of i.v. iron preparation (FCM vs. IIM-OR = 20.8; 95% CI, 2.6-166; p = 0.004). The median time with hypophosphatemia was 41 days, but prolonged hypophosphatemia of ≥ 2 months was documented in 13 of 17 patients in whom follow-up was available. A significant increase in the phosphaturic hormone intact FGF-23 in hypophosphatemic patients shows that this adverse event is caused by FCM-induced hormone dysregulation | ||
| 520 | |a CONCLUSION: Treatment with FCM is associated with a high risk of developing severe and prolonged hypophosphatemia and should therefore be monitored. Hypophosphatemia risk appears to be substantially lower with IIM | ||
| 650 | 4 | |a Journal Article | |
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| 700 | 1 | |a Würtinger, Philipp |e verfasserin |4 aut | |
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| 700 | 1 | |a Viveiros, André |e verfasserin |4 aut | |
| 700 | 1 | |a Effenberger, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Sulzbacher, Irene |e verfasserin |4 aut | |
| 700 | 1 | |a Moschen, Alexander |e verfasserin |4 aut | |
| 700 | 1 | |a Griesmacher, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Tilg, Herbert |e verfasserin |4 aut | |
| 700 | 1 | |a Vogel, Wolfgang |e verfasserin |4 aut | |
| 700 | 1 | |a Zoller, Heinz |e verfasserin |4 aut | |
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