title: Effect of ferric carboxymaltose on serum phosphate and C-terminal FGF23 levels in non-dialysis chronic kidney disease patients: post-hoc analysis of a prospective study.
abstract: BACKGROUND
  Some parenteral iron therapies have been found to be associated with hypophosphatemia. The mechanism of the decrease in serum phosphate is unknown. The aim of this study is to examine the effect of IV ferric carboxymaltose(FCM) on phosphate metabolism and FGF23 levels in patients with chronic kidney disease(CKD).
  
  
  METHODS
  This is a post-hoc analysis of a prospective study carried out in 47 non-dialysis CKD patients with iron-deficiency anaemia who received a single 1000 mg injection of FCM. Markers of mineral metabolism (calcium, phosphate, 1,25-dihydroxyvitamin D, PTH and FGF23[c-terminal]) were measured prior to FCM administration and at week 3 and week 12 after FCM administration. Based on the measured levels of serum phosphate at week 3, patiens were classified as hypophosphatemic or non-hypophosphatemic.
  
  
  RESULTS
  Serum phosphate levels decreased significantly three weeks after FCM administration and remained at lower levels at week 12 (4.24 ± 0.84 vs 3.69 ± 1.10 vs 3.83 ± 0.68 mg/dL, respectively, p < 0.0001. Serum calcium, PTH and 1,25-dihydroxyvitamin D did not change over the course of the study. Serum FGF23 decreased significantly from 442(44.9-4079.2) at baseline to 340(68.5-2603.3) at week 3 and 191.6(51.3-2465.9) RU/mL at week 12, p < 0.0001. Twelve patients were non-hypophosphatemic and 35 hypophosphatemic. FGF23 levels decreased in both groups, whereas no changes were documented in any of the other mineral parameters.
  
  
  CONCLUSIONS
  In non-dialysis CKD patients, FCM induces reduction in serum phosphate levels that persists for three months. FCM causes a significant decrease in FGF23 levels without changes to other bone metabolism parameters.
authors.forename: Merche
authors.initials: M
authors.lastname: Prats
authors.forename: Ramon
authors.initials: R
authors.lastname: Font
authors.forename: Carmen
authors.initials: C
authors.lastname: García
authors.forename: Carmen
authors.initials: C
authors.lastname: Cabré
authors.forename: Manel
authors.initials: M
authors.lastname: Jariod
authors.forename: Alberto Martinez
authors.initials: AM
authors.lastname: Vea
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005290:Ferric Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000097:blood*; D006801:Humans; D008297:Male; D008320:Maltose / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D010710:Phosphates / Q000037:antagonists & inhibitors / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D005290:Ferric Compounds; D010710:Phosphates; D005346:Fibroblast Growth Factors; C522335:ferric carboxymaltose; D008320:Maltose; D000089703:Fibroblast Growth Factor-23
references.citation: Hematology Am Soc Hematol Educ Program. 2010;2010:338-47
references.pmid: 21239816
references.citation: J Bone Miner Res. 2012 May;27(5):1132-41
references.pmid: 22247037
references.citation: Am J Nephrol. 2011;33(5):421-6
references.pmid: 21502756
references.citation: Nephrol Dial Transplant. 2012 Jun;27(6):2263-9
references.pmid: 22140123
references.citation: J Clin Endocrinol Metab. 2009 Jul;94(7):2332-7
references.pmid: 19366850
references.citation: Osteoporos Int. 2013 Mar;24(3):1121-4
references.pmid: 22648001
references.citation: Nat Rev Nephrol. 2010 Dec;6(12):699-710
references.pmid: 20956992
references.citation: J Clin Endocrinol Metab. 2011 Nov;96(11):3541-9
references.pmid: 21880793
references.citation: Bone. 2009 Oct;45(4):814-6
references.pmid: 19555782
references.citation: Am J Hematol. 1994 Aug;46(4):369-70
references.pmid: 8037194
references.citation: Nephrol Dial Transplant. 2011 May;26(5):1599-607
references.pmid: 20929915
references.citation: Ther Apher Dial. 2012 Apr;16(2):146-51
references.pmid: 22458393
references.citation: Endocrinology. 2009 Nov;150(11):4835-45
references.pmid: 19819968
references.citation: Eur J Pharm Biopharm. 2011 Aug;78(3):480-91
references.pmid: 21439379
references.citation: Proc Natl Acad Sci U S A. 2011 Nov 15;108(46):E1146-55
references.pmid: 22006328
references.citation: Nephrol Dial Transplant. 2013 Apr;28(4):953-64
references.pmid: 23222534
references.citation: Int J Pediatr Endocrinol. 2012 Oct 26;2012(1):27
references.pmid: 23098062
references.citation: Ann Clin Biochem. 2009 Mar;46(Pt 2):167-9
references.pmid: 19151167
references.citation: Bone Marrow Transplant. 2000 May;25(9):1015-6
references.pmid: 10800074
references.citation: Endocr J. 1998 Aug;45(4):431-9
references.pmid: 9881891
references.citation: Toxicol Lett. 2009 Dec 15;191(2-3):211-5
references.pmid: 19735707
references.citation: Bone. 2008 Jun;42(6):1235-9
references.pmid: 18396126
references.citation: J Clin Endocrinol Metab. 2006 Jun;91(6):2055-61
references.pmid: 16551733
references.citation: Kidney Int. 1994 Apr;45(4):1006-13
references.pmid: 8007569
references.citation: J Bone Miner Res. 2011 Jun;26(6):1188-96
references.pmid: 21308772
references.citation: Am J Med. 2012 Oct;125(10):991-999.e1
references.pmid: 22998881
references.citation: Clin Nephrol. 2013 Mar;79(3):237-40
references.pmid: 23182397
references.citation: Am J Kidney Dis. 2013 Jun;61(6):992-1000
references.pmid: 23375852
references.citation: J Am Soc Nephrol. 2006 May;17(5):1305-15
references.pmid: 16597685
references.citation: Am J Kidney Dis. 1992 Dec;20(6):580-4
references.pmid: 1462986
references.citation: J Am Soc Nephrol. 2007 Feb;18(2):382-93
references.pmid: 17229908
references.citation: Fukuoka Igaku Zasshi. 1984 Jun;75(6):316-26
references.pmid: 6489911
references.citation: Drugs. 2009;69(6):739-56
references.pmid: 19405553
references.citation: Ann Intern Med. 2006 Aug 15;145(4):247-54
references.pmid: 16908915
references.citation: Am J Obstet Gynecol. 2008 Oct;199(4):435.e1-7
references.pmid: 18928998
references.citation: Clin Exp Nephrol. 2013 Jun;17(3):416-23
references.pmid: 23180041
references.citation: J Bone Miner Res. 2013 Aug;28(8):1793-803
references.pmid: 23505057
references.citation: Kidney Int. 2004 Jul;66(1):144-56
references.pmid: 15200421
references.citation: J Am Soc Nephrol. 2002 Nov;13(11):2783-6
references.pmid: 12397050
references.citation: Ann Clin Biochem. 2007 Sep;44(Pt 5):463-6
references.pmid: 17761032
references.citation: Transfusion. 2009 Dec;49(12):2719-28
references.pmid: 19682342
references.citation: Clin Nephrol. 2009 Feb;71(2):125-9
references.pmid: 19203504
references.citation: Nephrol Dial Transplant. 2010 Aug;25(8):2722-30
references.pmid: 20190247
references.citation: Curr Med Res Opin. 2010 Feb;26(2):473-82
references.pmid: 20014980
references.citation: J Lab Clin Med. 2005 Jul;146(1):25-9
references.pmid: 16025088
references.citation: Rinsho Ketsueki. 1998 May;39(5):386-91
references.pmid: 9637890