Hyperuricemia, hypertension, and proteinuria associated with high-altitude polycythemia

Jefferson, J. Ashley; Escudero, Elizabeth; Hurtado, María Elena; Kelly, Jackeline Pando; Swenson, Erik R.; Wener, Mark H.; Burnier, Michel; Maillard, Marc; Schreiner, George F.; Schoene, Robert B.; Hurtado, Abdías; Johnson, Richard J.

doi:10.1053/ajkd.2002.33380

Cited by 95 publications

(82 citation statements)

References 28 publications

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“…Interestingly, the presence of albuminuria was significantly associated with high hemoglobin, which is in line with a study reporting a positive correlation between polycythemia and proteinuria among individuals living in a high altitude 16. High hemoglobin levels could increase blood viscosity,32 and this increased viscosity could elevate systemic blood pressure and glomerular perfusion pressure,33 which can lead to albuminuria 34.…”

Section: Discussionsupporting

confidence: 85%

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Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Ishigami

Grams

Naik

et al. 2018

JAHA

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BackgroundReduced estimated glomerular filtration rate (eGFR) and elevated urinary albumin‐to‐creatinine ratio (ACR) individually increase risk of cardiovascular disease (CVD). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels.Methods and ResultsUsing 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996–1998, we explored the cross‐sectional association of eGFR and ACR with hemoglobin levels and their longitudinal associations with CVD (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (<13 g/dL in men and <12 g/dL in women) and 7.2% had high hemoglobin (≥16 g/dL in men and ≥15 g/dL in women). The adjusted prevalence ratio of anemia was 2.12 (95% confidence interval, 1.59–2.82) for eGFR 30 to 59 compared with ≥90 mL/min per 1.73 m2 and 1.45 (1.07–1.95) for ACR ≥30 compared with <10 mg/g. ACR ≥30 mg/g was also associated with high hemoglobin (prevalence ratio, 1.57 [1.12–2.19] compared with <10 mg/g). During follow‐up, there were 1069 incident CVDs among 5098 CVD‐free participants at baseline. In multivariable Cox models, lower eGFR, higher ACR, and anemia were each independently associated with CVD risk, with the association of low eGFR being slightly stronger in anemia (P‐for‐interaction, 0.072). There was no hemoglobin‐ACR interaction; however, when CVD subtypes were analyzed separately, risk of coronary heart disease and stroke associated with high ACR was slightly stronger in high hemoglobin (P‐for‐interaction, 0.074).ConclusionsKidney function, albuminuria, and anemia were correlated and independently associated with CVD risk. Correlation and potential interaction for atherosclerotic CVD between albuminuria and high hemoglobin deserve further investigation.

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Section: Discussionsupporting

confidence: 85%

“…A few cross‐sectional studies of diabetic population showed positive association between albuminuria and anemia,14, 15 whereas a study of individuals living in high‐altitude showed an association between proteinuria and high hemoglobin 16. No studies have explored a potential interaction between albuminuria and hemoglobin in terms of future risk of CVD.…”

mentioning

confidence: 99%

Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Ishigami

Grams

Naik

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…64 In a small clinical study we conducted in Peru, we found that uric acid levels tend to increase with rising hematocrit and are significantly greater in subjects with CMS compared with those living at sea level. 47 A large epidemiologic study in Tibet also found a significant increased prevalence of hyperuricemia in Tibetans compared with prior studies performed among Han Chinese people living in Guangzhou. 46 Moreover, subjects living at high altitude also have a low fractional excretion of uric acid despite the high serum levels of uric acid 47 ; similar findings have been described in congenital cyanotic heart disease.…”

Section: Hyperuricemia and Hypertensionmentioning

confidence: 82%

“…47 A large epidemiologic study in Tibet also found a significant increased prevalence of hyperuricemia in Tibetans compared with prior studies performed among Han Chinese people living in Guangzhou. 46 Moreover, subjects living at high altitude also have a low fractional excretion of uric acid despite the high serum levels of uric acid 47 ; similar findings have been described in congenital cyanotic heart disease. 65 Interestingly, the higher prevalence of hyperuricemia associates with both the presence of microalbuminuria and systemic hypertension.…”

Section: Hyperuricemia and Hypertensionmentioning

confidence: 82%

“…46 Proteinuria increases with higher hematocrit. In one study, 6/27 (22%) of CMS patients had proteinuria Ͼ1 g/24 h. 47 The pathogenesis of the proteinuria may relate to a variety of factors, including the effects of tissue hypoxia within kidney parenchyma, glomerular capillary hypertension, hyperviscosity, and elevated right heart pressures. The proteinuria may also relate to the hyperuricemia commonly observed at high altitude (see below).…”

Section: Microalbuminuria and Proteinuriamentioning

confidence: 99%

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