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Letters
June 17, 2009

Association Between Altitude and Mortality in Incident Dialysis Patients

JAMA. 2009;301(23):2442-2443. doi:10.1001/jama.2009.843

To the Editor: The study by Dr Winkelmayer and colleagues1 attributed the observation of elevated hematocrit in patients with ESRD on maintenance hemodialysis living at higher altitudes to a 2008 report by Brookhart et al.2 However, in 1967 I described 2 anuric patients with ESRD on maintenance hemodialysis who were able to maintain a hemoglobin concentration of 11 to 12 g/dL without transfusion who both lived at altitude, one in Lauterbrunnen (1000 m above sea level) in the Bernese Oberland, Switzerland, and the other in Amman, Jordan (1200 m above sea level).3 Neither patient had polycystic kidneys and both had had multiple transfusions for their anemia prior to commencing dialysis.

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