Sudden death in chronic dialysis patients

Methods. Causes of sudden death were investigated in113 chronic dialysis patients who died during the 10-year period from July1979 to January 1989; post-mortem examination was performed on 93 of thecases (autopsy rate; 82.3%). Sudden death was regarded as death 24 h afterthe onset of acute illness in patients without any restriction in theirdaily activities. There were 35 sudden death cases out of the 93 autopsiedchronic dialysis patients. We analysed the causes of sudden death for allchronic dialysis patients and for those who died suddenly.Results. The mean age of the 93 cases was 61.4± 10.5 years (±SD). Stroke was the most frequentcause of death (24 cases, 25.8%) in the 93 autopsied cases. This wasfollowed by cardiac disease in 18 (19.4%), infectious disease in 16(17.2%), malignancy in 14 (15.1%), and dissecting aortic aneurysm in 5(5.4%). The mean age of the 35 sudden death cases was 60.9 ±10.9 years. Of the 35 sudden death cases in chronic dialysis patients,dissecting aortic aneurysm was the most common cause of sudden death (5cases, 14.3%), followed by cerebral haemorrhage in three (8.6%), acutesubdural haematoma in three (8.6%), acute myocardial infarction in two(5.7%), cerebral infarction in two (5.7%), and subarachnoidal haemorrhagein one (2.9%). Conclusions. Dissecting aorticaneurysm, leading frequently to stroke as a cause of sudden death inchronic dialysis patients, at least in Japan, should be carefullydifferentiated from other cardiac disease in chronic dialysis patients,such as severe atherosclerosis.