ArticleInternal and emergency medicine2026
Hypophosphatemia after intravenous ferric carboxymaltose in lung transplant recipients.
Article in Internal and emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06112236 (Effects of Treatments for Anemia and Iron Deficiency on the Electrolyte Balance in Lung Transplant Recipients), which is not on this map. Not yet cited in PubMed.
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Effects of Treatments for Anemia and Iron Deficiency on the Electrolyte Balance in Lung Transplant Recipients: A Special Focus on Hypophosphatemia
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9 authors.
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Abstract
backgroundIntravenous ferric carboxymaltose (FCM) is frequently used to treat iron deficiency in lung transplant recipients (LTRs). Hypophosphatemia is a known adverse event after FCM administration, with reported significant hypophosphatemia following FCM administration in renal and heart transplant recipients. This study aimed to assess the incidence of hypophosphatemia after FCM administration and to identify potential risk factors in LTRs.
methodsThis retrospective, single-center study included LTRs treated with FCM during post-transplant follow-up between 2015 and 2022 at the University Hospital Zurich. Patients were included if serum phosphate was measured within six months before and after FCM infusion. Phosphate levels and clinical data were extracted from electronic records, and hypophosphatemia was classified by severity. Changes in phosphate levels over time were analyzed using mixed-effects models, and multivariable logistic regression was used to identify predictors of hypophosphatemia. Of note, phosphate measurements were obtained at routine follow-up visits, with the first post-infusion measurement occurring at a median of 32 days.
resultsAmong 110 LTRs receiving FCM, 54.5% (n = 60) developed hypophosphatemia (≤ 0.81 mmol/L). Mild, moderate, and severe hypophosphatemia occurred in 23.6% (n = 26), 24.5% (n = 27), and 6.4% (n = 7) of patients, respectively. Use of 1000 mg FCM was associated with a higher risk of hypophosphatemia compared to 500 mg (OR (95% CI) of 2.54 (1.15-5.59)), increasing further after adjusting for baseline phosphate (OR (95% CI) of 5.18 (1.90-14.14)). Among patients with new-onset hypophosphatemia, 76% recovered within a median of 56 days. No serious clinical adverse events directly attributable to hypophosphatemia were documented.
conclusionsHypophosphatemia frequently occurred after FCM infusion in LTRs, particularly following higher doses. Transplant physicians should be mindful of this risk and consider using individualized FCM doses or alternative intravenous iron formulations with lower hypophosphatemia risk, such as ferric derisomaltose in this population.
trial registrationwww. CLINICALTRIALS: gov , NCT06112236.
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