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

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