title: Causes of death in patients with childhood-onset type 1 diabetes receiving dialysis in Japan: Diabetes Epidemiology Research International (DERI) Mortality Study.
abstract: OBJECTIVE
  To investigate the causes of death and how they changed over time in patients with childhood-onset type 1 diabetes who were receiving dialysis.
  
  
  METHODS
  Of the 1384 patients who were diagnosed with type 1 diabetes at<18 years of age between 1965 and 1979, 113 who were subsequently confirmed as having received dialysis and having died as of January 1, 2008 were found eligible for the study. The cause of death trends were expressed according to the duration of dialysis.
  
  
  RESULTS
  The leading causes of death were end-stage renal disease (ESRD) (36.3%), cardiovascular disease (CVD) (31.9%), and infections (20.3%). Among CVD, cerebral hemorrhage was the most frequent (38.9%) and showed a significant trend for an increase in the duration of dialysis (P=0.01, the Cochran-Armitage trend test). The mortality from ESRD concentrated within 5 years of dialysis and that from CVD increased after 10 years of dialysis, while the mortality from infections peaked during 5 to 10 years from initiation of dialysis.
  
  
  CONCLUSIONS
  The leading causes of death in dialysis patients with type 1 diabetes were ESRD, CVD, and infections. As the duration of dialysis increased, however, CVD contributed more to mortality. Special attention should be paid to CVD, particularly cerebral hemorrhage, to improve the long-term prognosis of patients.
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan. Electronic address: morohoshy@gmail.com.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Onda
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan; Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261, USA. Electronic address: rimei.nishimura@gmail.com.
authors.forename: Rimei
authors.initials: R
authors.lastname: Nishimura
authors.affiliation: Department of Internal Medicine, Morimoto Hospital, 2-2-5 Honcho Kichijoji, Musashino-shi, Tokyo, 180-0004, Japan. Electronic address: aya.morimoto@hoku.cc.
authors.forename: Aya
authors.initials: A
authors.lastname: Morimoto
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan. Electronic address: hirosano@jikei.ac.jp.
authors.forename: Hironari
authors.initials: H
authors.lastname: Sano
authors.affiliation: Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan. Electronic address: kazu-utsunomiya@jikei.ac.jp.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Utsunomiya
authors.affiliation: Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan. Electronic address: naokopgh@gmail.com.
authors.forename: Naoko
authors.initials: N
authors.lastname: Tajima
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D038622:Internationality; D007564:Japan; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
keywords: Cardiovascular disease; Cause of death; Childhood-onset; Dialysis; Type 1 diabetes