High Risk of Hypophosphatemia in Patients with Previous Bariatric Surgery Receiving Ferric Carboxymaltose: A Prospective
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ORIGINAL CONTRIBUTIONS
High Risk of Hypophosphatemia in Patients with Previous Bariatric Surgery Receiving Ferric Carboxymaltose: A Prospective Cohort Study Manuela Schoeb 1 & Andrea Räss 1 & Nicola Frei 2 & Stefan Aczél 1 & Michael Brändle 1,2 & Stefan Bilz 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Iron deficiency is a common finding in patients with previous bariatric surgery, and parenteral supplementation is frequently required. Ferric carboxymaltose (FCM) is among the preferred compounds used but may be associated with new-onset hypophosphatemia. This study was undertaken to study the prevalence of hypophosphatemia following FCM in patients with previous bariatric surgery, a population that may be at particular risk due to highly prevalent secondary hyperparathyroidism. Methods Patients with previous bariatric surgery and iron depletion scheduled for FCM infusion were prospectively studied before and one week after FCM application. The primary endpoint was new-onset hypophosphatemia. Patients were followed until plasma phosphate had normalized without replacement. Results Fifty-two patients (40 females) following Roux-en-Y gastric bypass (n = 50) or sleeve gastrectomy (n = 2), with a median age of 46 years (range 22–68) and a BMI of 32.2 kg/m2 (27.5–37.3), were analyzed. Fifteen patients (29%) developed new-onset hypophosphatemia, with 11 (21%) requiring oral phosphate supplementation for a median duration of 14 days (14–25). The plasma phosphate decreased by 0.3 mmol/l (−0.5–−0.2; p < 0.001) secondary to a 56% increase in the fractional urinary phosphate excretion (p < 0.001). This was associated with a significant increase in serum intact FGF23 (+30%; p < 0.001) and a decrease in serum 1,25(OH)2 vitamin D3 concentrations (−37.6%; p < 0.001). Conclusion Patients with previous bariatric surgery receiving FCM are at considerable risk of developing significant hypophosphatemia secondary to increased renal phosphate wasting through a mechanism involving FGF23. Monitoring plasma phosphate should be considered following FCM in patients with previous bariatric surgery. Clinical trial registration ISRCTN registry, ISRCTN12291677, https://www.isrctn.com Keywords Roux-en-Y gastric bypass . Sleeve gastrectomy . Iron deficiency . Ferric carboxymaltose (FCM) . Fibroblast growth factor 23 (FGF23) . Hypophosphatemia
Introduction Iron deficiency due to decreased oral intake, hypoacidity of the remaining stomach and limited enteral absorption is a Michael Brändle and Stefan Bilz share co-senior authorship Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04544-x) contains supplementary material, which is available to authorized users. * Manuela Schoeb [email protected] 1
Division of Endocrinology and Diabetes, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland
2
Division of General Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
common finding in patients following
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