Could Low Altitude Predict the Use of Erythropoietin-Stimulating Agents in Hemodialysis Patients?

Altitude may influence the requirement for erythropoiesis-stimulating agent (ESA) therapy in patients undergoing hemodialysis (HD). This study aimed to compare anemia-related parameters, ESA utilization, and intravenous (IV) iron supplementation among HD patients residing at different altitudes.

This retrospective-multicenter study was conducted in three provinces of Türkiye, each located at a distinct altitude: Balikesir (139 m; low-altitude-group [LA]), Malatya (964 m; moderate-altitude-group [MA]), and Hakkari (1728 m; high-altitude-group[HA]).

Two hundred and twenty nine HD patients were included in the study: 99 in the LA group, 77 in the MA group, and 53 in the HA group. The mean age was 59 ± 13 years. ESA use was observed in 92 (93%) patients in the LA group, 61 (73%) in the MA group, and 43 (81%) in the HA group (p = 0.021). Age (OR: 1.102, 95% CI: 1.035-1.174, p = 0.003), female gender (OR: 6.068, 95% CI: 1.080-34.111, p = 0.041), residing at LA (OR: 12.845, 95% CI: 1.833-90.118, p = 0.010), IV iron use (OR: 21.015, 95% CI: 3.397-130.009, p = 0.001), hematocrit (OR: 0.364, 95% CI: 0.229-0.578, p < 0.001), and ferritin (OR: 1.003, 95% CI: 1.001-1.005, p = 0.007) were identified as independent predictors of ESA use.

Residing at LA was associated with increased ESA requirements in HD patients, suggesting that altitude may be a relevant factor in anemia management.