Document Detail


The effect of altitude change on anemia treatment response in hemodialysis patients.
MedLine Citation:
PMID:  21345929     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hemodialysis patients who live at high altitude use less exogenous erythropoietin but achieve higher hematocrit levels than those living at a lower altitude. The authors hypothesized that the effect of altitude would be strongest in hemodialysis patients with poor anemia treatment response. To explore this hypothesis, they studied anemia-related outcomes in US hemodialysis patients who move to higher altitudes. Using Medicare and US Geological Survey data, in 1992-2004 they identified instances in which a patient moved from a dialysis center at an altitude of <2,000 feet (600 m) to one at a higher elevation. Of these moves, 5,274 were ≥3,000 feet (900 m; the altitude group) and 25,345 were 250-500 feet (75-150 m; the control group). Among patients with poor treatment response at baseline, large increases in hematocrit and decreases in erythropoietin dosing were observed in the altitude relative to the control group. At 6 months, hematocrit had increased more in the altitude group (5.1%, 95% confidence interval (CI): 4.1, 6.2 vs. 3.7%, 95% CI: 3.5, 3.9), and erythropoietin dosing decreased more (4,600 units/week, 95% CI: 500, 8,700 vs. 1,700 units/week, 95% CI: 1,000, 2,400). No effect of altitude was observed in patients with better treatment response at baseline. These results support the hypothesis that altitude-induced hypoxia reduces erythropoietin requirements in hemodialysis patients with treatment-refractory anemia.
Authors:
M Alan Brookhart; Brian D Bradbury; Jerry Avorn; Sebastian Schneeweiss; Wolfgang C Winkelmayer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-02-23
Journal Detail:
Title:  American journal of epidemiology     Volume:  173     ISSN:  1476-6256     ISO Abbreviation:  Am. J. Epidemiol.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-05     Completed Date:  2011-06-28     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  7910653     Medline TA:  Am J Epidemiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  768-77     Citation Subset:  IM    
Affiliation:
Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC 27599-7435, USA. abrookhart@unc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Altitude*
Anemia / drug therapy*,  epidemiology,  etiology
Confounding Factors (Epidemiology)
Erythropoietin / administration & dosage*
Female
Hematocrit
Humans
Kidney Failure, Chronic / therapy*
Male
Middle Aged
Models, Statistical
Renal Dialysis / adverse effects*
Residence Characteristics
Risk Factors
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
AG027400/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
11096-26-7/Erythropoietin
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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