Life-threatening hypophosphatemia following intravenous iron infusion

Vasquez-Rios, George; Chapel, Ashley; Philip, Isaac; Martin, Kévin; Merando, Adam

doi:10.1016/j.nefro.2020.03.007

Cited by 5 publications

(32 citation statements)

References 7 publications

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“…In the headto-head trials described earlier, severe hypophosphatemia was observed following treatment with FCM, but not with FDI [28] or FER [49]. Although these trials did not report on related symptoms, numerous isolated patient reports describing acute symptomatic hypophosphatemia following treatment with FCM have been published [68][69][70][71][72][73]. In a review paper published in 2017, Zoller et al discussed the long-term complications of hypophosphatemia following IV iron treatment, such as bone fractures and osteomalacia [44].…”

Section: Clinical Consequences Of Hypophosphatemia In the Setting Of IV Iron Treatmentmentioning

confidence: 99%

Newer formulations of intravenous iron: a review of their chemistry and key safety aspects – hypersensitivity, hypophosphatemia, and cardiovascular safety

Blumenstein

Shanbhag

Langguth

et al. 2021

Expert Opinion on Drug Safety

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Introduction:The newest intravenous (IV) iron products show an improved safety profile over predecessors, allowing for the rapid administration of relatively high doses. Ferric derisomaltose (FDI; also known as iron isomaltoside), ferric carboxymaltose (FCM), and ferumoxytol (FER), are successful treatments for iron deficiency (Europe; FDI and FCM) and iron deficiency anemia (US; FDI, FCM, and FER).Areas covered: This review focusses on the chemistry and structure of FDI, FCM, and FER, and on three key aspects of IV iron safety: (1) hypersensitivity; (2) hypophosphatemia and sequelae; (3) cardiovascular safety. Expert opinion: Although the safety of modern IV iron has improved, immediate infusion reactions and the development of hypophosphatemia must be appreciated and recognized by those who prescribe and administer IV iron. Immediate infusion reactions can occur with any IV iron and are usually mild; severe reactions -particularly anaphylaxis -are extremely rare. The recognition and appropriate management of infusion reactions is an important consideration to the successful administration of IV iron. Severe, persistent, hypophosphatemia is a specific side effect of FCM. No cardiovascular safety signal has been identified for IV iron. Ongoing trials in heart failure will provide additional long-term efficacy and safety data.

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Section: Clinical Consequences Of Hypophosphatemia In the Setting Of IV Iron Treatmentmentioning

confidence: 99%

Newer formulations of intravenous iron: a review of their chemistry and key safety aspects – hypersensitivity, hypophosphatemia, and cardiovascular safety

Blumenstein

Shanbhag

Langguth

et al. 2021

Expert Opinion on Drug Safety

View full text Add to dashboard Cite

show abstract

“…(11,12,16,19,33,37) Muscular symptoms were present in 13 cases, (12)(13)(14)16,17,23,(25)(26)(27)(28)31,32,35) gait disturbances in 6, (13,14,16,19,23,30) fatigue and malaise in 3, (17,24,25) and hyperexcitability linked to hypocalcemia in 3. (22,26,35) Bone imaging Bone mineral density was reported in 16 patients; in 5 it was normal, (18,20,30,36,37) 3 had osteopenia, (14,23,24) and 8 had osteoporosis. (13)(14)(15)(16)19,(32)(33)(34) In 2 cases, bone mineral density (BMD) was also available after hypophosphatemia recovery and both showed increases; an 8% increase in femoral neck BMD and 19% increase in lumbar spine (LS) after 12 months was reported by Tournis…”

Section: Laboratory Testsmentioning

confidence: 99%

“…The most common treatments initiated were phosphate supplementation and active forms of vitamin D. Oral phosphate was prescribed in 18 cases (11,(13)(14)(15)(16)19,20,(23)(24)(25)(26)(27)(28)(29)(30)(33)(34)(35) and intravenous phosphate in 4. (11,16,17,35) In 2 patients, milk was recommended as a source of phosphate.…”

Section: Treatment Of Osteomalaciamentioning

confidence: 99%

“…(11,16,17,35) In 2 patients, milk was recommended as a source of phosphate. (32,38) Active vitamin D (oral alphacalcidol or calcitriol) was prescribed for 17 patients (11,13,14,16,19,20,(22)(23)(24)27,(29)(30)(31)(32)34,35) and in 1 case intravenous calcitriol. (35) However, there was little information available about the dose; Bishay and colleagues reported the use of 0.25 mcg/d of oral calcitriol, (14) whereas Reyes and colleagues reported the use of calcitriol 0.25 mcg t.i.d.…”

Section: Treatment Of Osteomalaciamentioning

confidence: 99%

“…(24) Vasquez-Rios reported the use of 1 to 3 mcg/d calcitriol intravenously. (35) Alphacalcidol dose was reported in 2 case reports and varied from 1 to 2 mcg/d. (27,32) Five patients received cholecalciferol (14,15,26,27,29) and 5 received calcium supplementation.…”

Section: Treatment Of Osteomalaciamentioning

confidence: 99%

See 2 more Smart Citations

Osteomalacia as a Complication of Intravenous Iron Infusion: A Systematic Review of Case Reports

Vilaça

Velmurugan

Smith

et al. 2020

Journal of Bone and Mineral Research

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Randomized control trials (RCTs) have shown that certain intravenous iron preparations can induce high levels of fibroblast growth factor 23 (FGF-23) and persistent hypophosphatemia. Repeated iron infusions may lead to prolonged hypophosphatemia and osteomalacia events not captured by RCTs. Several previous case reports have described skeletal adverse effects after repeated iron infusions. To characterize these effects, we conducted a systematic review of case reports. MEDLINE, Embase, Web of Science, and Cochrane databases were searched in March 2021. We selected case reports of patients ≥16 years old. Study quality was assessed using the tool from Murad and colleagues. We report the results in a narrative summary. We identified 28 case reports, reporting 30 cases. Ages ranged from 28 to 80 years (median 50 years). Most patients (n = 18) received ferric carboxymaltose (FCM), whereas 8 received saccharated ferric oxide (SFO) and 3 received iron polymaltose (IPM). All but 2 cases had more than five infusions (range 2 to 198, median 17). The lowest phosphate levels ranged from 0.16 to 0.77 mmol/L (median 0.36 mmol/L). Intact FGF-23 (iFGF-23) was high when measured. Serum 25OH vitamin D was low in 10 of 21 cases measured and 1,25(OH) 2 vitamin D in 12 of 18. Alkaline phosphatase was high in 18 of 22 cases. Bone or muscle pain was reported in 28 of the 30 cases. Twenty patients had pseudofractures, 9 had fractures, and 6 patients had both. All 15 available bone scans showed focal isotope uptake. Case reports tend to report severe cases, so potential reporting bias should be considered. Osteomalacia is a potential complication of repeated iron infusion, especially in patients with gastrointestinal disorders receiving prolonged therapy. Pain and fractures or pseudofractures are common clinical findings, associated with low phosphate, high iFGF-23, high alkaline phosphatase, and abnormal isotope bone scan. Discontinuing or switching the iron formulation was an effective intervention in most cases.

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Neue Aspekte zur Eisentherapie des RLS in der Praxis – Teil 2

Goischke¹

2021

psychopraxis. neuropraxis

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Life-threatening hypophosphatemia following intravenous iron infusion

Cited by 5 publications

References 7 publications

Newer formulations of intravenous iron: a review of their chemistry and key safety aspects – hypersensitivity, hypophosphatemia, and cardiovascular safety

Newer formulations of intravenous iron: a review of their chemistry and key safety aspects – hypersensitivity, hypophosphatemia, and cardiovascular safety

Osteomalacia as a Complication of Intravenous Iron Infusion: A Systematic Review of Case Reports

Neue Aspekte zur Eisentherapie des RLS in der Praxis – Teil 2

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