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June 17, 2009, Vol 301, No. 23 >

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Letters | June 17, 2009

Association Between Altitude and Mortality in Incident Dialysis Patients

Robert Scragg, MBBS, PhD; Ravi Thadhani, MD, MPH; Carlos A. Camargo, MD, DrPH
JAMA. 2009;301(23):2442-2443. doi:10.1001/jama.2009.842.
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To the Editor: In their cohort analysis of incident dialysis patients, Dr Winkelmayer and colleagues1 speculated that the inverse association observed between altitude and all-cause mortality in both dialysis patients and the general US population may be due to hypoxia-induced regulation of enzymes to reduce cardiovascular risk.

Another possible explanation of their findings is that populations living at high altitudes have higher vitamin D levels, which reduces their risk of cardiovascular disease compared with those living at sea level.2 UV-B radiation, which is the primary source of vitamin D in humans, increases with altitude by about 15% per 1000 m because of decreasing ozone.2 Moreover, the photoconversion of 7-dehydrocholesterol to previtamin D3 has been shown to increase with altitude, particularly above 2000 m.3

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

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June 17, 2009
Association Between Altitude and Mortality in Incident Dialysis Patients
Ji Young Shin, MD; William C. Steinmann, MD, MSc
JAMA. 2009;301(23):2442-2443. doi:10.1001/jama.2009.841.
June 17, 2009
Association Between Altitude and Mortality in Incident Dialysis Patients
Stanley Shaldon, MA, MD
JAMA. 2009;301(23):2442-2443. doi:10.1001/jama.2009.843.
June 17, 2009
Association Between Altitude and Mortality in Incident Dialysis Patients—Reply
Wolfgang C. Winkelmayer, MD, ScD, MPH; M. Alan Brookhart, PhD
JAMA. 2009;301(23):2442-2443. doi:10.1001/jama.2009.844.
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