Urbanization and Altitude Are Associated with Low Kidney Function in Peru

Rodrigo M. Carrillo-Larco, J. Jaime Miranda, Robert H Gilman, Offdan Narvaez-Guerra, Karela Herrera-Enriquez, Josefina Medina-Lezama, Liam Smeeth, William Checkley, Antonio Bernabe-Ortiz

Research output: Contribution to journalArticle

Abstract

Background: Kidney health needs to be studied in low- A nd middle-income countries with populations living at high altitude and undergoing urbanization. We studied whether greater level of urbanization was associated with worse kidney function and higher hemoglobin was associated with worse kidney function at high altitude. Methods: Cross-sectional analysis of population-based studies in Peru including five sites at different altitude above the sea level and urbanization level (in decreasing order of urbanization): Lima (sea level), Arequipa (2335 m), urban Puno (3825 m), Tumbes (sea level), and rural Puno (3825 m). The exposures were urbanization and altitude as per study site, and hemoglobin (g/dL). The outcome was the estimated glomerular filtration rate (eGFR). Results: Four thousand two hundred eight people were studied: Mean age was 57.4 years (standard deviation: 12.4) and 51.9% were women. In comparison to rural Puno, eGFR was similar in Lima; in comparison to rural Puno, Arequipa, urban Puno, and Tumbes had worse eGFR, for example, in Arequipa, β =-8.07 (95% confidence interval [CI]:-10.90 to-5.24). Intermediate (β =-8.60; 95% CI:-10.55 to-6.66) and high (β =-11.21; 95% CI:-14.19 to-8.24) altitude were negatively correlated with eGFR when only urban places were analyzed. At high altitude, there was a trend for a negative association between hemoglobin and eGFR: β =-1.09 (95% CI:-2.22 to 0.04). Conclusions: Apparently, higher altitude and level of urbanization, except for one highly urbanized site, were associated with worse kidney function. Our findings suggest that some of the adverse impact of high altitude on kidney function has been balanced by the lower risk conferred by rural environments.

Original languageEnglish (US)
Pages (from-to)133-140
Number of pages8
JournalHigh Altitude Medicine and Biology
Volume20
Issue number2
DOIs
StatePublished - Jun 1 2019

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Urbanization
Peru
Kidney
Glomerular Filtration Rate
Oceans and Seas
Confidence Intervals
Hemoglobins
Population
Cross-Sectional Studies
Health

Keywords

  • Altitude
  • chronic kidney disease
  • glomerular filtration
  • kidney function
  • Peru
  • urbanization

ASJC Scopus subject areas

  • Physiology
  • Public Health, Environmental and Occupational Health

Cite this

Carrillo-Larco, R. M., Miranda, J. J., Gilman, R. H., Narvaez-Guerra, O., Herrera-Enriquez, K., Medina-Lezama, J., ... Bernabe-Ortiz, A. (2019). Urbanization and Altitude Are Associated with Low Kidney Function in Peru. High Altitude Medicine and Biology, 20(2), 133-140. https://doi.org/10.1089/ham.2018.0106

Urbanization and Altitude Are Associated with Low Kidney Function in Peru. / Carrillo-Larco, Rodrigo M.; Miranda, J. Jaime; Gilman, Robert H; Narvaez-Guerra, Offdan; Herrera-Enriquez, Karela; Medina-Lezama, Josefina; Smeeth, Liam; Checkley, William; Bernabe-Ortiz, Antonio.

In: High Altitude Medicine and Biology, Vol. 20, No. 2, 01.06.2019, p. 133-140.

Research output: Contribution to journalArticle

Carrillo-Larco, RM, Miranda, JJ, Gilman, RH, Narvaez-Guerra, O, Herrera-Enriquez, K, Medina-Lezama, J, Smeeth, L, Checkley, W & Bernabe-Ortiz, A 2019, 'Urbanization and Altitude Are Associated with Low Kidney Function in Peru', High Altitude Medicine and Biology, vol. 20, no. 2, pp. 133-140. https://doi.org/10.1089/ham.2018.0106
Carrillo-Larco RM, Miranda JJ, Gilman RH, Narvaez-Guerra O, Herrera-Enriquez K, Medina-Lezama J et al. Urbanization and Altitude Are Associated with Low Kidney Function in Peru. High Altitude Medicine and Biology. 2019 Jun 1;20(2):133-140. https://doi.org/10.1089/ham.2018.0106
Carrillo-Larco, Rodrigo M. ; Miranda, J. Jaime ; Gilman, Robert H ; Narvaez-Guerra, Offdan ; Herrera-Enriquez, Karela ; Medina-Lezama, Josefina ; Smeeth, Liam ; Checkley, William ; Bernabe-Ortiz, Antonio. / Urbanization and Altitude Are Associated with Low Kidney Function in Peru. In: High Altitude Medicine and Biology. 2019 ; Vol. 20, No. 2. pp. 133-140.
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abstract = "Background: Kidney health needs to be studied in low- A nd middle-income countries with populations living at high altitude and undergoing urbanization. We studied whether greater level of urbanization was associated with worse kidney function and higher hemoglobin was associated with worse kidney function at high altitude. Methods: Cross-sectional analysis of population-based studies in Peru including five sites at different altitude above the sea level and urbanization level (in decreasing order of urbanization): Lima (sea level), Arequipa (2335 m), urban Puno (3825 m), Tumbes (sea level), and rural Puno (3825 m). The exposures were urbanization and altitude as per study site, and hemoglobin (g/dL). The outcome was the estimated glomerular filtration rate (eGFR). Results: Four thousand two hundred eight people were studied: Mean age was 57.4 years (standard deviation: 12.4) and 51.9{\%} were women. In comparison to rural Puno, eGFR was similar in Lima; in comparison to rural Puno, Arequipa, urban Puno, and Tumbes had worse eGFR, for example, in Arequipa, β =-8.07 (95{\%} confidence interval [CI]:-10.90 to-5.24). Intermediate (β =-8.60; 95{\%} CI:-10.55 to-6.66) and high (β =-11.21; 95{\%} CI:-14.19 to-8.24) altitude were negatively correlated with eGFR when only urban places were analyzed. At high altitude, there was a trend for a negative association between hemoglobin and eGFR: β =-1.09 (95{\%} CI:-2.22 to 0.04). Conclusions: Apparently, higher altitude and level of urbanization, except for one highly urbanized site, were associated with worse kidney function. Our findings suggest that some of the adverse impact of high altitude on kidney function has been balanced by the lower risk conferred by rural environments.",
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AU - Herrera-Enriquez, Karela

AU - Medina-Lezama, Josefina

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N2 - Background: Kidney health needs to be studied in low- A nd middle-income countries with populations living at high altitude and undergoing urbanization. We studied whether greater level of urbanization was associated with worse kidney function and higher hemoglobin was associated with worse kidney function at high altitude. Methods: Cross-sectional analysis of population-based studies in Peru including five sites at different altitude above the sea level and urbanization level (in decreasing order of urbanization): Lima (sea level), Arequipa (2335 m), urban Puno (3825 m), Tumbes (sea level), and rural Puno (3825 m). The exposures were urbanization and altitude as per study site, and hemoglobin (g/dL). The outcome was the estimated glomerular filtration rate (eGFR). Results: Four thousand two hundred eight people were studied: Mean age was 57.4 years (standard deviation: 12.4) and 51.9% were women. In comparison to rural Puno, eGFR was similar in Lima; in comparison to rural Puno, Arequipa, urban Puno, and Tumbes had worse eGFR, for example, in Arequipa, β =-8.07 (95% confidence interval [CI]:-10.90 to-5.24). Intermediate (β =-8.60; 95% CI:-10.55 to-6.66) and high (β =-11.21; 95% CI:-14.19 to-8.24) altitude were negatively correlated with eGFR when only urban places were analyzed. At high altitude, there was a trend for a negative association between hemoglobin and eGFR: β =-1.09 (95% CI:-2.22 to 0.04). Conclusions: Apparently, higher altitude and level of urbanization, except for one highly urbanized site, were associated with worse kidney function. Our findings suggest that some of the adverse impact of high altitude on kidney function has been balanced by the lower risk conferred by rural environments.

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