{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:35:58Z","timestamp":1793730958332,"version":"4.6.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nephrol"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Intravenous iron is commonly used in patients with non-dialysis-dependent chronic kidney disease (CKD). Modern intravenous iron compounds (e.g. ferric derisomaltose (FDI), ferric carboxymaltose (FCM)) are increasingly utilized with similar efficacy. A differential effect in terms of hypophosphatemia has been noted following administration of FCM, which may be related to fibroblast growth factor 23 (FGF23). This study was designed to examine the\u00a0comparative effects of FDI and FCM on FGF23, phosphate and other markers of bone turnover.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The single-center double-blind randomized controlled trial \u201cIron and Phosphaturia \u2013 ExplorIRON-CKD\u201d primarily assessed the effects of FCM and FDI on intact FGF23 and phosphate, whilst also studying the impact on vitamin D, parathyroid hormone and phosphaturia. Bone markers including alkaline phosphatase, bone-specific alkaline phosphatase, procollagen type 1 N-terminal propeptide and carboxy-terminal collagen cross-linked telopeptide were monitored. Non-dialysis-dependent CKD patients (stage 3a-5) with iron deficiency with\/without anemia (serum ferritin < 200 \u00b5g\/L or transferrin saturation = 20% and serum ferritin 200-299 \u00b5g\/L) were randomized to receive FDI or FCM in a 1:1 ratio. At baseline 1000 mg of intravenous iron was administered followed by 500-1000 mg at 1 month to achieve replenishment. Measurements were performed at baseline, 1\u20132 days following iron administration, 2 weeks, 1 month (second iron administration), 1\u20132 days following second administration, 2 months and 3 months following initial infusion.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Twenty-six patients participated in the trial; 14 randomized to FDI and 12 to FCM. Intact FGF23 increased following administration of iron, and the increase was significantly higher with FCM compared to FDI (Baseline to 1\u20132 days following 1st administration: FDI: 3.0 (IQR: - 15.1 - 13.8) % vs. FCM: 146.1 (IQR: 108.1\u2013203.1) %;\n p<\/jats:italic>\n < 0.001 and Baseline to 1\u20132 days following 2nd administration: FDI: 3.2 (IQR: - 3.5 \u2013 25.4) % vs. FCM: 235.1 (138.5\u2013434.6) %;\n p<\/jats:italic>\n = 0.001). Phosphate levels decreased in the FCM group, causing a significant difference versus FDI 2 weeks following administration of the first dose. A significantly greater decrease in 1,25 (OH)\n 2<\/jats:sub>\n Vitamin D was noted with FCM. Several markers of bone turnover significantly changed following administration of FCM but not FDI.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The study suggests a differential effect on FGF23 following administration of FCM compared to FDI in non-dialysis-dependent CKD patients, similar to other patient groups. This may lead to changes consistent with hypovitaminosis D and alterations in bone turnover with potential clinical consequences. Further definitive studies are required to understand these differences of intravenous iron compounds.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) number: 2019\u2013004370-26 (\n https:\/\/www.clinicaltrialsregister.eu\/ctr-search\/trial\/2019-004370-26\/GB<\/jats:ext-link>\n ) (First date of trial registration: 03\/12\/2019).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s12882-023-03440-7","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T07:02:29Z","timestamp":1707721349000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The differential effect of modern intravenous iron on fibroblast growth factor 23 and phosphate in non-dialysis dependent CKD \u2013 the exploratory randomized controlled double-blind ExplorIRON-CKD study"],"prefix":"10.1186","volume":"25","author":[{"given":"Xenophon","family":"Kassianides","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Bhandari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"key":"3440_CR1","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1093\/ckj\/sfz091","volume":"13","author":"MMY Wong","year":"2020","unstructured":"Wong MMY, Tu C, Li Y, Perlman RL, Pecoits-Filho R, Lopes AA, et al. 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The trial received the favorable opinion of the Health Research Authority and the Research Ethics Committee Leeds West (20\/YH\/0005), and clinical trial authorization by the Medicines and Healthcare Products Regulatory Agency of the United Kingdom. Study participants had all details explained to them in writing and in person before giving informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"XK has no conflicts of interest. SB has received honorarium for lectures, attended expert opinion committees and received educational funds to attend international Nephrology meetings from Pharmacosmos A\/S and Vifor Pharma.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"54"}}