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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.

Financial Disclosures: Dr Shaldon reported being a consultant to Fresenius Medical Care Germany and having been a consultant to Nipro Ltd Japan.

Stanley Shaldon, MA, MD
stanley.shaldon@libello.com
Monaco

1. Winkelmayer WC, Liu J, Brookhart MA. Altitude and all-cause mortality in incident dialysis patients. JAMA. 2009;301(5):508-512. FREE FULL TEXT 2. Brookhart MA, Schneeweiss S, Avorn J; et al. The effect of altitude on dosing and response to erythropoietin in ESRD. J Am Soc Nephrol. 2008;19(7):1389-1395. FREE FULL TEXT 3. Shaldon S. Chronic dialysis without transfusion. Lancet. 1967;289(7493):783-784.

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(23):2443.

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