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.
Shaldon S. Association Between Altitude and Mortality in Incident Dialysis Patients. JAMA. 2009;301(23):2442–2443. doi:10.1001/jama.2009.843
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