Causes of death in insulin-dependent diabetic patients treated with hemodialysis.

Causes of death were analyzed for 63 diabetic patients treated with hemodialysis. In all cases, autopsy-based death certificates were evaluated. The causes of death were compared during the periods 1969 through 1979 versus 1980 through 1987, and the causes of death in patients who died after less than 18 months versus those who died greater than 18 months after starting hemodialysis treatment. Our population of decreased diabetics had a mean age of 41.8 years, with a mean of 23.4 years of diabetes duration. The mean age at manifestation of diabetes was 18.2 years. Cardiac failure has been shown to be the most prevalent cause of death (55.6%), while sepsis accounted for 20.6% of the deaths. In both the period from 1969 through 1979 and that from 1980 through 1987, cardiac failure was identified as the commonest cause of death, with an equal proportion of septic causes (i.e., 20% versus 21.05%). When comparing causes of death among diabetics on hemodialysis for less than 18 months versus those receiving greater than 18 months of treatment, cardiac failure was responsible for 54% versus 61.5% of deaths. Septic causes were found to be more prevalent after a longer duration of treatment (i.e., 30.8%). Therefore, it is concluded that to prevent cardiac deaths, blood pressure control has to be as tight as possible in patients with diabetic kidney disease. To prevent late-occurring septic deaths, good nutritional status in patients undergoing hemodialysis seems to be of importance. The prevention of macroangiopathy in diabetes represents a major medical problem that needs to be solved.