Abstract: FR-OR124

Influence of Altitude of Residence on the Prevalence of Anemia of CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular


  • Argyropoulos, Christos, University of New Mexico, Albuquerque, New Mexico, United States
  • Pankratz, V. Shane, UNM Health Sciences Center, Albuquerque, New Mexico, United States
  • Myers, Orrin, University of New Mexico, Albuquerque, New Mexico, United States
  • Unruh, Mark L., University of New Mexico, Albuquerque, New Mexico, United States
  • Norris, Keith C., UCLA, Marina Del Rey, California, United States
  • Vassalotti, Joseph A., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Hypoxia is the major regulator of erythropoietin production in the kidney. There are currently minimal data about the prevalence of anemia in patients with varying degrees of CKD who reside in high altitudes.


We undertook an exploratory analysis of the National Kidney Education Kidney Early Evaluation Program. Participant's address were geocoded to geographic coordinates using National Elevation US Database and the altitude of the residence of each participant in KEEP was determined. We examined prevalence of anemia (Hemoglobin, Hgb < 10g/dL) against the severity of CKD (eGFR) and other predictors after weighting the KEEP participants to the US census, in order to account for the self-selection bias in KEEP.


In multivariate analyses, race, ACR, personal history of anemia (Table), age (a relationship that differed between women Figure A and men Figure B), eGFR and altitude were significant predictors of the odds of anemia (p<0.001). Predicted prevalence of anemia was half at 2.0 km elevation vs. sea level for all eGFR values (Figures C,D). There was no interaction between altitude and eGFR.


The odds of anemia differ for individuals residing at different altitudes. This relationship likely contributes to geographic disparities of CKD complications. Further studies should examine the response to iron and ESA according to altitude.

Categorical associations with anemia
VariableOdds Ratio (95% CI)
Race (Caucasian = ref)1
Black3.53 (2.89 – 4.31)
American Indian3.47 (2.30 – 5.24)
Other2.25 (1.79 – 2.82)
ACR (<30 = ref)1
ACR 30-300 mg/g1.79 (1.41 – 2.27)
ACR >300 mg/g2.02 (1.18 – 3.48)
Personal Hx of Anemia10.7 (7.68 – 15.0)

ACR : Albumin-Creatinine Ratio (random urine)


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