Sakhuja A, Stephany B, Deitzer D, Kumar G, Schold J D
Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio.
Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio.
Transplant Proc. 2014 Jun;46(5):1353-61. doi: 10.1016/j.transproceed.2014.01.019.
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.
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.
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).
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.
肺栓塞（PE）是院内死亡的重要原因，在肾移植患者和维持性透析患者中很常见。黑人患者的PE发病率较高；然而，透析患者和肾移植后患者中按种族划分的PE发病率和结局趋势差异尚不清楚。
在这项观察性研究中，对肾移植患者、维持性透析患者和普通人群中PE住院率和死亡率进行了研究。比较了不同种族组的发病率。还检查了肾移植状态作为死亡率的预测因素。
普通人群、透析患者和肾移植组的PE发病率分别为每10万人70.5例、518.8例和158.8例。所有组中黑人的发病率更高。所有组中PE入院的年龄调整发病率随时间增加，非移植组中黑人的增加幅度更大（黑人透析组的斜率为112.1，白人透析组为49.4；P = 0.001；普通人群中黑人的斜率为9.3，白人的斜率为3.4；P = 0.003）。普通人群的死亡率与肾移植组无显著差异（3.4%对1.9%，P = 0.2）；然而，低于透析组的6.8%（P < 0.001）。白人和黑人之间的死亡率没有差异。维持性透析是死亡率的独立预测因素（比值比[OR]1.94；95%置信区间[CI]1.62 - 2.32）。
肾移植患者的PE比普通人群更常见，但比维持性透析患者少见。PE住院的死亡率在肾移植患者和普通人群之间不明确，但透析患者更高。PE住院的发病率不仅在黑人中更高，而且在维持性透析患者和普通人群中，该群体的发病率增长不成比例。
