Comparative Risk of Hypophosphatemia Following the Administration of Intravenous Iron Formulations: A Network Meta-Analysis

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#administration-intravenous #anemia-iron-deficiency #bayes-theorem #ferric-compounds #hematinics

Comparative Risk of Hypophosphatemia Following the Administration of Intravenous Iron Formulations: A Network Meta-Analysis

Bellos et al., 2020 | Transfus Med Rev | Systematic Review

Citation

Bellos Ioannis, Frountzas Maximos, Pergialiotis Vasilios. Comparative Risk of Hypophosphatemia Following the Administration of Intravenous Iron Formulations: A Network Meta-Analysis. Transfus Med Rev. 2020-Jul;34(3):188-194. doi:10.1016/j.tmrv.2020.07.002

Abstract

Intravenous iron therapy is increasingly used in patients with iron deficiency anemia, although concerns of hypophosphatemia have been recently raised. The aim of this study was to evaluate different intravenous iron formulations for the risk of hypophosphatemia. Medline, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Clinicaltrials.gov, and Google Scholar databases were systematically searched to 20 March 2020. All randomized controlled trials reporting the incidence of hypophosphatemia among adult patients treated with any intravenous iron preparation were included. Pool estimates were obtained by applying an arm-based Bayesian network meta-analysis model. Eight randomized controlled trials were included, comprising 5989 patients. Ferric carboxymaltose was associated with significantly higher incidence of hypophosphatemia compared to iron isomaltoside (risk ratio [RR]: 7.90, 95% confidence interval [CI]: 2.10-28.0), iron sucrose (RR: 9.40, 95% CI: 2.30-33.0), iron dextran (RR: 6.60, 95% CI: 1.91-220.0), and ferumoxytol (RR: 24.0, 95% CI: 2.50-220.0). Therefore, ferric carboxymaltose ranked as the worst treatment presenting the highest surface under the cumulative ranking curve (99.1%). No significant differences were estimated for the comparisons among iron isomaltoside, iron sucrose, iron dextran, and ferumoxytol. In conclusion, it is suggested that the occurrence of hypophosphatemia is common after the administration of intravenous ferric carboxymaltose. Further research is needed in large-scale randomized controlled trials to determine the risk of symptomatic and persistent hypophosphatemia as well as to elucidate the exact pathophysiology of the observed association.

Key Findings

Further research is needed in large-scale randomized controlled trials to determine the risk of symptomatic and persistent hypophosphatemia as well as to elucidate the exact pathophysiology of the observed association.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population adult patients
Sample Size 5989
Age Range See abstract
Condition deficiency

MeSH Terms

  • Administration, Intravenous
  • Anemia, Iron-Deficiency
  • Bayes Theorem
  • Ferric Compounds
  • Hematinics
  • Humans
  • Hypophosphatemia
  • Incidence
  • Risk Factors

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Comparative Study, Journal Article, Systematic Review, Network Meta-Analysis
  • Vertical: iron

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09