Effects of iron isomaltoside vs ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia: two randomized clinical trials.

Wolf M, Rubin J, Achebe M, et al.
JAMA 2020;323:432-443.
NATA Rating :
Review by : M. Auerbach
NATA Review

This article describes a new physiology via the upregulation of FGF23 by ferric carboxymaltose (FCM) with subsequent development of hypophosphatemia.  It provides a degree of caution with the long-term use of this formulation of IV iron but aptly points out that clinically significant hypophosphatemia is rare. 

What this should do is stimulate long-term evaluation of the safety of this widely used product. The paper also appropriately points out the need to monitor phosphorus levels as a routine part of FCM’s use.

The physiology is beautifully described and the reader will know much more about renal physiology after reading the manuscript. 

– Michael Auerbach

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