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- Title
High Risk of Hypophosphatemia in Patients with Previous Bariatric Surgery Receiving Ferric Carboxymaltose: A Prospective Cohort Study.
- Authors
Schoeb, Manuela; Räss, Andrea; Frei, Nicola; Aczél, Stefan; Brändle, Michael; Bilz, Stefan
- 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
- Subjects
GASTRIC bypass; BARIATRIC surgery; HYPOPHOSPHATEMIA; CLINICAL trial registries; LONGITUDINAL method; CHOLECALCIFEROL
- Publication
Obesity Surgery, 2020, Vol 30, Issue 7, p2659
- ISSN
0960-8923
- Publication type
Article
- DOI
10.1007/s11695-020-04544-x