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Chronic Kidney Disease at High Altitude

Andrew M. Luks^*, Richard J. Johnson and Erik R. Swenson^*,

^* Division of Pulmonary and Critical Care Medicine, University of Washington, and Division of Pulmonary and Critical Care Medicine, VA Puget Sound Health Care System Seattle, Washington; and Division of Renal Diseases and Hypertension, University of Colorado, Denver, Colorado

Correspondence: Dr. Erik R. Swenson, Pulmonary and Critical Care Medicine, VA Puget Sound Health Care System, University of Washington, 1660 South Columbian Way, Seattle, WA 98108. Phone: 206-764-2668; Fax: 206-764-2659; E-mail: eswenson{at}u.washington.edu

With a prevalence of 10 to 11% in the general population, it is likely that many patients with chronic kidney disease will visit or reside in mountainous areas. Little is known, however, about whether short- or long-duration, high-altitude exposure poses a risk in this patient population. Given that many areas of the kidney are marginally oxygenated even at sea level and that kidney disease may result in further renal hypoxia and hypoxia-associated renal injury, there is concern that high altitude may accelerate the progression of chronic kidney disease. In this review, we address how chronic kidney disease and its management is affected at high altitude. We postulate that arterial hypoxemia at high altitude poses a risk of faster disease progression in those with preexisting kidney disease. In addition, we consider the risks of developing acute altitude illness in patients with chronic kidney disease and the appropriate use of medications for the prevention and treatment of these problems.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673