Smokers' Polycythemia

Smith, J. Bruce; Landaw, Stephen A.

doi:10.1056/nejm197801052980102

Cited by 217 publications

(93 citation statements)

References 24 publications

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“…Cigarette smoke contains carbon monoxide, and inhalation leads to carboxyhemoglobinemia and hypoxemia; in fact, smoking may cause polycythemia. 9 A physiologic link between cellulitis/gangrene and Endogenous EPO status is not readily explained.…”

Section: Discussionmentioning

confidence: 99%

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Goodkin

Fuller

Robinson

et al. 2011

Journal of the American Society of Nephrology

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A small percentage of hemodialysis patients maintain higher hemoglobin concentrations without transfusion or erythropoietic therapy. Because uncertainty exists regarding the effects of higher hemoglobin concentration on mortality and quality of life among hemodialysis patients, studying this group of patients with sufficient endogenous erythropoietin may provide additional insights. The prospective, observational Dialysis Outcomes and Practice Patterns Study provides an opportunity to investigate this group. Among 29,796 patients in 12 nations, 545 (1.8%) maintained hemoglobin concentrations Ͼ12 g/dl for 4 months without erythropoietic support. This subset tended to be male, to have a longer duration of end-stage renal disease, and to not dialyze via a catheter. Cystic disease as the underlying cause of renal failure was over-represented in this group but was present in only 25%. Lung disease, smoking, and cardiovascular disease were associated with increased likelihood of naturally higher hemoglobin concentration. Quality-of-life scores were not higher among this subset compared with the other patients. Unadjusted mortality risk for patients with hemoglobin Ͼ12 g/dl and no erythropoietic therapy was lower than for the other patients, but after thorough adjustment for case mix, there was no difference between groups (relative risk, 0.98; 95% CI 0.80 to 1.19). These data show that naturally occurring hemoglobin concentration Ͼ12 g/dl does not associate with increased mortality among hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Goodkin

Fuller

Robinson

et al. 2011

Journal of the American Society of Nephrology

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“…Smoking habits, which are known to affect hematocrit, 23 - 24 were investigated by means of a questionnaire administered by the physician. To validate this information, the level of carbon monoxide in the breath, taken as an index of smoking habit, 25 was measured with an Ecolyzer instrument (Pittsburgh, Pa.) in 76.9% of men and 72.7% of women in our sample.…”

Section: Methodsmentioning

confidence: 99%

Hematocrit, blood pressure, and hypertension. The Gubbio Population Study.

et al. 1992

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Baseline data from the Gubbio Population Study in north central Italy were used to investigate the relation of hematocrit to blood pressure and hypertension among 2,809 men and women aged 25-74 years. Independent of gender, age, and other confounders, the hypertensive group had a higher hematocrit than the nonhypertensive group (p<0.001). In comparison with the untreated hypertensive group, the hypertensive group being treated with diuretics or with other drugs only had similar mean hematocrit levels despite significantly lower blood pressures. Hematocrit was positively correlated with systolic pressure (r=0.085,p<0.01 andr=0.264,p<0.001 for men and women, respectively) and diastolic pressure (r=0.214, p<0.001 and r=0.266, p<0.001). In both sexes, whether or not the treated hypertensive group was included, age-adjusted prevalence of hypertension and average blood pressure were higher for persons in higher qulntiles of hematocrit (/><0.001). The association of hematocrit with blood pressure and hypertension was significant and independent of several confounders. The regression coefficient of blood pressure on hematocrit ranged between 0.410 and 0.620 mm Hg per unit of hematocrit for systolic pressure and between 0371 and 0.581 for diastolic pressure, depending on gender and whether the treated hypertensive group was included in multiple regression analysis. Based on exponentiation of the multiple logistic coefficient, prevalence of hypertension was at least two times greater for persons whose hematocrit levels were higher by 10 units. (Hypertension 1992^20-319-326) KEY WORDS • hematocrit • blood pressure • hypertension, essential • Gubbio population study H ematocrit is the most important determinant of whole blood viscosity. 1 Blood viscosity and vascular resistance affect total peripheral resistance to blood flow, 2 which is abnormally high in the established phase of primary hypertension.3 It has been reported that hematocrit is increased or normal in human hypertension*-9 and increased in rat genetic hypertension. 8 -10 In genetically hypertensive rats, it has also been shown that reduction of hematocrit with maintenance of blood volume reduces blood pressure.11 -13 Correspondingly, clinical studies have reported that increase of hematocrit is followed by increase in blood pressure and possibly onset of hypertension in anemic patients.14 - 20From the Division of Nephrology, First Medical School (M.C), University of Naples "Federico II," Naples; the Center for Epi Many clinical and experimental studies have been done on the relation between hematocrit and blood pressure, but the epidemiological literature does not identify hematocrit as an important independent correlate of blood pressure in general populations. The present study of men and women from the Gubbio Population Study in north central Italy 21 shows that a significant positive association exists between hematocrit and blood pressure or hypertension, independent of other factors related to these end points. MethodsIn the Gubbio Study, the target pop...

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“…112 With tissue hypoxia, regardless of cause, as the red cell mass increases there is usually a concomitant reduction in plasma volume. Given the other factors involved in plasma volume regulation as well as in its measurement, the magnitude of plasma volume reduction reported with hypoxic erythrocytosis due to right-to-left cardiac shunts, 113 impaired pulmonary gas exchange, 114 carbon monoxide poisoning, 115 and low ambient oxygen tension 116 varies but the downward trend is unmistakable. It should not be surprising, therefore, that therapy with recombinant erythropoietin, 117 androgenic steroids, 118 and even blood transfusion 119 also leads to a reduction in plasma volume; the mechanisms involved are unknown but may in part be protective since increasing whole blood viscosity suppresses endogenous erythropoietin production.…”

Section: Measurement Of the Red Cell Mass And Plasma Volumementioning

confidence: 99%