Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience
Yıl: 2021 Cilt: 9 Sayı: 2 Sayfa Aralığı: 201 - 206 Metin Dili: İngilizce DOI: 10.4274/nkmj.galenos.2021.38258 İndeks Tarihi: 12-10-2021
Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience
Öz: Aim: The aim of this study was to evaluate the incidence of hypophosphatemia after ferric carboxymaltose (FCM) infusion and the factors affectinghypophosphatemia.Materials and Methods: Ninety-two patients who received FCM treatment for iron deficiency anemia (IDA) were included in the study. Phosphorus,calcium, magnesium, 25-hydroxy vitamin D, and parathyroid hormone levels before and after FCM infusion were obtained from the medical records.Hypophosphatemia was defined as serum phosphorus level of <2.5 mg/dL and severe hypophosphatemia as <1 mg/dL. The cut-off value for baselinephosphorus in predicting hypophosphatemia was detected as 3.4 mg/mL with the ROC analysis.Results: Seventy-seven of the patients were women. The mean age was 47.5±15.5 (18-85) years. Thirty of the patients (32.6%) were given 500mg iron as FCM and 62 patients (67.4%) were given 1000 mg iron as FCM. The level of serum phosphorus measured 10-14 days after FCM wasdetermined lower than the baseline level (2.22±0.57 mg/dL vs 3.34±0.39 mg/dL, p<0.000). Hypophosphatemia was observed in 62 patients (67.4%)after FCM infusion. Severe hypophosphatemia was seen in only 2 patients (2.1%). Patients given a dose of 1000 mg FCM had a higher incidenceof hypophosphatemia compared to those given 500 mg FCM (75.8% vs 50%, p=0.013). Baseline phosphorus level of 3.4 mg/dL was associatedwith an increased risk of developing hypophosphatemia with an odds ratio of 9.2 (p=0.001; 95% confidence interval: 3.41-25.21). On logisticregression analysis, it was found that baseline phosphorus level and a dose of 1000 mg FCM were independent risk factors for the development ofhypophosphatemia.Conclusion: The incidence of hypophosphatemia due to FCM in our study was consistent with the literature. When FCM treatment is given topatients with IDA, the patients should be evaluated according to their baseline phosphorus level, the dose of FCM and frequency of administration,and it should be kept in mind to follow the phosphorus level in patients with risk for hypophosphatemia.
Anahtar Kelime: Demir Karboksimaltoz Tedavisi Sonrası Hipofosfatemi Sıklığı: Tek Merkez Deneyimi
Öz: Amaç: Demir karboksimaltoz (DKM) infüzyonu sonrası hipofosfatemi sıklığını ve hipofosfatemiye etki eden faktörleri değerlendirmek amaçlanmıştır. Gereç ve Yöntem: Demir eksikliği anemisi (DEA) nedeniyle DKM tedavisi alan 92 hasta çalışmaya alındı. DKM öncesi ve sonrası fosfor, kalsiyum, magnezyum, 25-hidroksi vitamin D, parathormon seviyeleri dosya bilgilerinden kaydedildi. Hipofosfatemi serum fosfor düzeyinin <2,5 mg/dL olması, ağır hipofosfatemi de <1 mg/dL olması şeklinde tanımlandı. Hipofosfatemiyi öngörmede bazal fosfor düzeyi için cut-off değeri ROC analizi ile 3,4 mg/dL olarak saptandı. Bulgular: Hastaların 77’si (%83,6) kadındı. Yaş ortalaması 47,5±15,5 (18-85) yıl idi. Hastaların 30’u (%32,6) 500 mg, 62’si (%67,4) ise 1000 mg dozunda DKM tedavisi aldı. DKM tedavisi sonrası 10.-14. gün bakılan serum fosfor düzeyi bazal değerine göre düşük bulundu (2,22±0,57 mg/dL vs 3,34±0,39 mg/dL, p<0,000). Altmış iki hastada (%67,4) tedavi sonrası hipofosfatemi gözlendi. Ağır hipofosfatemi sadece iki hastada (%2,1) görüldü. 1000 mg DKM alanlarda, 500 mg DKM alanlarla karşılaştırıldığında hipofosfatemi daha sıktı (%75,8 vs %50, p=0,013). Bazal fosfor düzeyinin ≤3,4 medianmg/ dL olması 9,2 bir olasılık oranıyla hipofosfatemi geliştirme riskinde artış ile ilişkili bulundu [(p=0,001, %95 güven aralığı: 3,41-25,21). Lojistik regresyon analizinde ise bazal fosfor düzeyi ve 1000 mg DKM dozunun hipofosfatemi gelişimi için bağımsız risk faktörleri olduğu tespit edildi. Sonuç: Çalışmamızda DKM’ye bağlı hipofosfatemi sıklığı literatür ile uyumlu idi. DEA olan hastalara DKM tedavisi verilirken bazal fosfor düzeyi, DKM dozu ve DKM uygulama sıklığına göre hastalar değerlendirilmeli; hipofosfatemi açısından riskli hastalarda fosfor seviyesinin takip edilmesi akılda tutulmalıdır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. World Health Organization. Iron Deficiency Anaemia Assessment, Prevention, and Control. A guide for programme managers. Switzerland: World Health Organization; 2001.
- 2. World Health Organization. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015.
- 3. Cancelo-Hidalgo MJ, Castelo-Branco C, Palacios S, Haya-Palazuelos J, Ciria-Recasens M, Manasanch J, et al. Tolerability of different oral iron supplements: a systematic review. Curr Med Res Opin. 2013;29:291-303.
- 4. Gereklioglu C, Asma S, Korur A, Erdogan F, Kut A. Medication adherence to oral iron therapy in patients with iron deficiency anemia. Pak J Med Sci. 2016;32:604-7.
- 5. Qunibi WY. The efficacy and safety of current intravenous iron preparations for the management of iron-deficiency anaemia: a review. Arzneimittelforschung. 2010;60:399-412.
- 6. Emrich IE, Lizzi F, Siegel JD, Seiler-Mussler S, Ukena C, Kaddu-Mulindwa D, et al. Hypophosphatemia after high-dose iron repletion with ferric carboxymaltose and ferric derisomaltose-the randomized controlled HOMe aFers study. BMC Med. 2020;18:178.
- 7. Wolf M, Rubin J, Achebe M, Econs MJ, Peacock M, Imel EA, et al. Effects of Iron Isomaltoside vs Ferric Carboxymaltose on Hypophosphatemia in Iron- Deficiency Anemia: Two Randomized Clinical Trials. JAMA. 2020;323:432- 43.
- 8. Wolf M, Chertow GM, Macdougall IC, Kaper R, Krop J, Strauss W. Randomized trial of intravenous iron-induced hypophosphatemia. JCI Insight. 2018;3:e124486.
- 9. World Health Organization, Worldwide Prevalance of Anemia 1993- 2005. WHO Global Database on Anaemia. Switzerland: World Health Organization; 2008.
- 10. Short MW, Domagalski JE. Iron deficiency anemia: evaluation and management. Am Fam Physician. 2013;87:98-104.
- 11. World Health Organization, International statistical classification of diseases and related health problems. - 10th revision, World Health Organization Geneva, Switzerland: 2016.
- 12. Cançado RD, Muñoz M. Intravenous iron therapy: how far have we come? Rev Bras Hematol Hemoter. 2011;33:461-9.
- 13. Bregman DB, Goodnough LT. Experience with intravenous ferric carboxymaltose in patients with iron deficiency anemia. Ther Adv Hematol. 2014;5:48-60.
- 14. Glaspy JA, Lim-Watson MZ, Libre MA, Karkare SS, Hadker N, Bajic-Lucas A, et al. Hypophosphatemia Associated with Intravenous Iron Therapies for Iron Deficiency Anemia: A Systematic Literature Review. Ther Clin Risk Manag. 2020;16:245-59.
- 15. Hardy S, Vandemergel X. Intravenous iron administration and hypophosphatemia in clinical practice. Int J Rheumatol. 2015;2015:468675.
- 16. Hanudel MR, Laster M, Salusky IB. Non-renal-Related Mechanisms of FGF23 Pathophysiology. Curr Osteoporos Rep. 2018;16:724-9.
- 17. Imel EA, Liu Z, McQueen AK, Acton D, Acton A, Padgett LR, et al. Serum fibroblast growth factor 23, serum iron and bone mineral density in premenopausal women. Bone. 2016;86:98-105.
- 18. Ifie E, Oyibo SO, Joshi H, Akintade O. Symptomatic hypophosphataemia after intravenous iron therapy: an underrated adverse reaction. Endocrinol Diabetes Metab Case Rep. 2019;2019:19-0065.
- 19. Callejas-Moraga EL, Casado E, Gomez-Nuñez M, Caresia-Aroztegui AP. Severe osteomalacia with multiple insufficiency fractures secondary to intravenous iron therapy in a patient with Rendu-Osler-Weber syndrome. Bone Rep. 2020;13:100712.
- 20. Fang W, McMahon LP, Bloom S, Garg M. Symptomatic severe hypophosphatemia after intravenous ferric carboxymaltose. JGH Open. 2019;3:438-40.
| APA | Terzi Demirsoy E (2021). Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. , 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| Chicago | Terzi Demirsoy Esra Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. (2021): 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| MLA | Terzi Demirsoy Esra Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. , 2021, ss.201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| AMA | Terzi Demirsoy E Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. . 2021; 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| Vancouver | Terzi Demirsoy E Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. . 2021; 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| IEEE | Terzi Demirsoy E "Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience." , ss.201 - 206, 2021. 10.4274/nkmj.galenos.2021.38258 |
| ISNAD | Terzi Demirsoy, Esra. "Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience". (2021), 201-206. https://doi.org/10.4274/nkmj.galenos.2021.38258 |
| APA | Terzi Demirsoy E (2021). Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. Namık Kemal Tıp Dergisi, 9(2), 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| Chicago | Terzi Demirsoy Esra Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. Namık Kemal Tıp Dergisi 9, no.2 (2021): 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| MLA | Terzi Demirsoy Esra Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. Namık Kemal Tıp Dergisi, vol.9, no.2, 2021, ss.201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| AMA | Terzi Demirsoy E Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. Namık Kemal Tıp Dergisi. 2021; 9(2): 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| Vancouver | Terzi Demirsoy E Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience. Namık Kemal Tıp Dergisi. 2021; 9(2): 201 - 206. 10.4274/nkmj.galenos.2021.38258 |
| IEEE | Terzi Demirsoy E "Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience." Namık Kemal Tıp Dergisi, 9, ss.201 - 206, 2021. 10.4274/nkmj.galenos.2021.38258 |
| ISNAD | Terzi Demirsoy, Esra. "Incidence of Hypophosphatemia after Ferric Carboxymaltose Treatment: Single Center Experience". Namık Kemal Tıp Dergisi 9/2 (2021), 201-206. https://doi.org/10.4274/nkmj.galenos.2021.38258 |
