ferric-carboxymaltose and Malabsorption-Syndromes

Phosphorus has an essential role in cellular and extracellular metabolism; maintenance of normal phosphorus homeostasis is critical. Phosphorus homeostasis can be affected by diet and certain medications; some intravenous iron formulations can induce renal phosphate excretion and hypophosphatemia, likely through increasing serum concentrations of intact fibroblast growth factor 23. Case studies provide insights into two types of hypophosphatemia: acute symptomatic and chronic hypophosphatemia, while considering the role of pre-existing conditions and comorbidities, medications, and intravenous iron. This review examines phosphorus homeostasis and hypophosphatemia, with emphasis on effects of iron deficiency and iron replacement using intravenous iron formulations.

Topics: Anemia, Hypochromic; Calcitriol; Ferric Compounds; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Homeostasis; Humans; Hypophosphatemia; Infusions, Parenteral; Iron; Iron Deficiencies; Kidney; Malabsorption Syndromes; Maltose; Osteomalacia; Parathyroid Hormone; Phosphorus; Phosphorus, Dietary

Iron deficiency anemia (IDA) is a common finding in patients after bariatric surgery. The cause is multifactorial including reduced oral iron intake and malabsorption. While many patients can be managed with oral supplements, parenteral iron may be needed to restore and maintain iron stores.. Subjects who had previous bariatric surgery and had participated in phase 3 industry-sponsored clinical trials designed to assess the safety and/or efficacy of intravenous (IV) ferric carboxymaltose (FCM) were retrospectively selected from the databases of each of these studies. Demographic data, efficacy measures [hemoglobin, ferritin, and transferrin saturation (TSAT)], and adverse events were compared between FCM and other agents utilized as comparators in the trials.. Two hundred eighty-one subjects from the intention to treat (ITT) population were included (mean age 49 years, BMI 33 kg/m(2), including 253 females). FCM had similar or improved efficacy (p < 0.05) in terms of increasing hemoglobin, ferritin, and TSAT values when compared to other iron products used as standard of care for IDA. The incidence of adverse events in the FCM patients (n = 123) versus patients receiving any IV iron (n = 126) was 61 and 56.3 %, respectively. The adverse events were similar in both groups with the exception of a transient decrease in serum phosphate which was observed more frequently in the FCM group.. These data in post-bariatric surgery IDA patients suggest that FCM is a safe and effective alternative to existing iron products permitting higher and thus less frequent individual doses.

Topics: Adult; Anemia, Iron-Deficiency; Bariatric Surgery; Biomarkers; Dietary Supplements; Dose-Response Relationship, Drug; Female; Ferric Compounds; Ferritins; Hematinics; Hemoglobins; Humans; Infusions, Intravenous; Iron, Dietary; Malabsorption Syndromes; Male; Maltose; Middle Aged; Obesity, Morbid; Parenteral Nutrition; Postoperative Complications; Randomized Controlled Trials as Topic; Retrospective Studies; Transferrin; Treatment Outcome; United States