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Steel, Stembridge et al... 2021.pdf (1.45 MB)

Global REACH 2018: volume regulation in high-altitude Andeans with and without chronic mountain sickness

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posted on 2021-10-19, 13:15 authored by Andrew R. Steele, Michael M. Tymko, Victoria L. Meah, Lydia L. Simpson, Christopher Gasho, Tony DawkinsTony Dawkins, Alexandra M. Williams, Francisco C. Villafuerte, Gustavo Vizcardo-Galindo, Rómulo J. Figueroa-Mujíca, Philip N. Ainslie, Mike Stembridge, Jonathan P. Moore, Craig D. Steinback
The high-altitude maladaptation syndrome known as chronic mountain sickness (CMS) is characterized by polycythemia and is associated with proteinuria despite unaltered glomerular filtration rate. However, it remains unclear if indigenous highlanders with CMS have altered volume regulatory hormones. We assessed NH2-terminal pro-B-type natriuretic peptide (NT pro-BNP), plasma aldosterone concentration, plasma renin activity, kidney function (urinary microalbumin, glomerular filtration rate), blood volume, and estimated pulmonary artery systolic pressure (ePASP) in Andean males without (n = 14; age = 39 ± 11 yr) and with (n = 10; age = 40 ± 12 yr) CMS at 4,330 m (Cerro de Pasco, Peru). Plasma renin activity (non-CMS: 15.8 ± 7.9 ng/mL vs. CMS: 8.7 ± 5.4 ng/mL; P = 0.025) and plasma aldosterone concentration (non-CMS: 77.5 ± 35.5 pg/mL vs. CMS: 54.2 ± 28.9 pg/mL; P = 0.018) were lower in highlanders with CMS compared with non-CMS, whereas NT pro-BNP was not different between groups (non-CMS: 1394.9 ± 214.3 pg/mL vs. CMS: 1451.1 ± 327.8 pg/mL; P = 0.15). Highlanders had similar total blood volume (non-CMS: 90 ± 15 mL·kg−1 vs. CMS: 103 ± 18 mL·kg−1; P = 0.071), but Andeans with CMS had greater total red blood cell volume (non-CMS: 46 ± 10 mL·kg−1 vs. CMS: 66 ± 14 mL·kg−1; P < 0.01) and smaller plasma volume (non-CMS: 43 ± 7 mL·kg−1 vs. CMS: 35 ± 5 mL·kg−1; P = 0.03) compared with non-CMS. There were no differences in ePASP between groups (non-CMS: 32 ± 9 mmHg vs. CMS: 31 ± 8 mmHg; P = 0.6). A negative correlation was found between plasma renin activity and glomerular filtration rate in both groups (group: r = −0.66; P < 0.01; non-CMS: r = −0.60; P = 0.022; CMS: r = −0.63; P = 0.049). A smaller plasma volume in Andeans with CMS may indicate an additional CMS maladaptation to high altitude, causing potentially greater polycythemia and clinical symptoms.


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American Journal of Physiology-Regulatory, Integrative and Comparative Physiology


American Physiological Society


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Steele, A.R., Tymko, M.M., Meah, V.L., Simpson, L.L., Gasho, C., Dawkins, T.G., Williams, A.M., Villafuerte, F.C., Vizcardo-Galindo, G.A., Figueroa-Mujíca, R.J. and Ainslie, P.N. (2021) 'Global REACH 2018: volume regulation in high-altitude Andeans with and without chronic mountain sickness', American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 321(3), pp.R504-R512.

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Cardiff Met Affiliation

  • Cardiff School of Sport and Health Sciences

Cardiff Met Authors

Tony Dawkins Mike Stembridge

Cardiff Met Research Centre/Group

  • Cardiovascular Physiology

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