We have an Espar 5 diesel hydronic heater, a 6 gallon Indel marine hot water heater and 2 heat exchangers with 2 speed fans.
The Espar can heat the hot water tank, heat the camper with the heat exchangers and / or pre heat the engine if necessary.
The engine can heat the camper and / or heat the hot water tank.
We have both the Espar timer control and a programmable thermostat to maintain a set temperature.
If we haven't been driving or using the furnace, we set the timer for 10 minutes and have plenty of hot water for 2 showers and dishes.
We used it for 3 years and have used it over 10,000 feet and have never had a problem.
As far as I know there isn't a limit to how cold the unit will operate. I've never used it below 5F.
How low an outside temperature and still be comfortable inside is a function of insulation, surface area of the floor, walls and roof, furnace size and how warm or cool you like it. At 10F outside and 68F inside our heater will run a little less than half the time, so I think we could still be comfortable at a considerable lower outside temperature.
The Espar 4 is about 14,000 btu and the Espar 5 is about 18000 btu. Get the muffler, it really helps.
I think the formula for calculating the btu required to maintain inside temperature of the camper (not raise it from cold) is:
(surface area in sq ft * (outside temp - inside temp)) / R factor of the insulation.
We have a heater with twice the calculated btu so I have extra capacity to raise the temperature of the camper from cold.
Allowing the engine to heat the camper and hot water while you drive makes it nice when you stop for lunch or the night.
At one time I believe you could purchase 2 different fuel pumps for the Espar 4 so you could adjust one for high altitude, but I don't believe that is possible anymore.
And we have never needed any help to work at high altitude.
The other stories about altitude problems have been associated with a diesel cooktop.
We've never had any trouble with our Wallas diesel cooktop because of altitude, but we've had starting problems that turned out to be low voltage, a bad electrical ground and wind blowing directly into the exhaust pipe.
Wallas now makes a version of the cooktop with a high altitude compensation button.