title: Trends of pulmonary embolism before and after kidney transplantation in black versus white patients.
abstract: BACKGROUND
  Pulmonary embolism (PE) is an important cause of in-hospital mortality and is common in renal transplantation and maintenance dialysis patients. PE incidence is higher among patients who are black; however, differences in trends of incidence and outcomes of PE by race among patients on dialysis and after renal transplantation is not well known.
  
  
  METHODS
  In this observational study, the incidences of PE hospitalizations and mortality were studied in those with renal transplant, on maintenance dialysis, and in general population. Incidences were compared across racial groups. Renal transplantation status as a predictor of mortality was also examined.
  
  
  RESULTS
  The incidences of PE in general population, dialysis, and renal transplant groups were 70.5, 518.8, and 158.8 per 100,000 population, respectively. Incidence was higher in blacks across all groups. The age-adjusted incidence of PE admissions increased over time in all groups with greater increase in blacks in non-transplant groups (the slope in dialysis for blacks was 112.1 versus that for whites at 49.4; P = .001; the slope in general population for blacks was 9.3 versus 3.4 for whites; P = .003). The mortality rate in general population was not significantly different than renal transplant group (3.4% versus 1.9%, P = .2); however, was lower than 6.8% seen in dialysis group (P < .001). The mortality rate was not different between whites and blacks. Maintenance dialysis was an independent predictor of mortality (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.62-2.32).
  
  
  CONCLUSIONS
  PE in those with renal transplant is more common than in general population but less common than those on maintenance dialysis. The mortality rate for PE hospitalizations is equivocal between renal transplant and general population but higher for patients on dialysis. The incidence of PE hospitalizations is not only higher among blacks, but is increasing disproportionately in this group among those who are on maintenance dialysis and within general population.
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio. Electronic address: asakhuja@alumni.mcw.edu.
authors.forename: A
authors.initials: A
authors.lastname: Sakhuja
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio.
authors.forename: B
authors.initials: B
authors.lastname: Stephany
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio.
authors.forename: D
authors.initials: D
authors.lastname: Deitzer
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: G
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D006435:Renal Dialysis; D012189:Retrospective Studies; D044465:White People; D055815:Young Adult