Effect of therapeutic erythrocytapheresis on outcomes and renal benefit in patients with high-altitude polycythemia: a real-world study

Kidney injury from high-altitude polycythemia (HAPC) is common, yet few studies have explored effective treatments. This research assessed the renal benefits of therapeutic erythrocytapheresis (TE) in HAPC patients, analyzing the efficacy of single versus multiple treatments. From 2017 to 2023, 631 patients undergoing TE were included. Findings showed notable improvements in hemoglobin levels (median: 228.00 vs. 169.00 g/L, p < 0.001), estimated glomerular filtration rate (eGFR) (median: 100.24 vs. 105.92 ml/min/1.73 m², p < 0.001), and uric acid levels (median 495.00 vs. 405.00 µmol/L, p < 0.001). The rate of patients with negative urine protein tests rose from 54.58 to 92.83%. Analysis indicated that a lower pre-treatment eGFR was associated with significant renal improvement post-treatment (OR 0.959, 95% CI 0.945-0.972, p < 0.001), even when adjusting for hemoglobin and other factors (OR 0.962, 95% CI 0.947-0.977, p < 0.001). After propensity score matching, 168 patients were categorized based on the number of treatments. Compared to single treatment, multiple treatments resulted in significantly lower hemoglobin levels post-treatment (median: 177.00 vs. 165.00 g/L, p < 0.001). TE proves to be a beneficial treatment for HAPC, improving hemoglobin and renal function. Multiple treatments may be preferable for maintaining stable hemoglobin levels.