We analyzed the causes of death in 109 patients who began hemodialysis therapy between 1969 and 1986 at the Akita Kumiai General Hospital. Patients with acute renal failure were excluded from this survey.
The main causes of death were cardiac failure (25.7%), cerebro-vascular accidents (19.3%), infections (17.4%) and sudden deaths (10.1%).
The proportion of deaths due to cardiac failure was relatively high during the first year of dialysis, although very small among the patients who were dialyzed for more them 5 years, and it was greatest among older patients (especially those older than 60 years of age).
The deaths from cerebro-vascular accidents were due predominantly to cerebral hemorrhage. Death due to cerebro-vascular accidents accounted for the largest proportion (45%) of the deaths in patients treated by hemodialysis for more than 5 years. In comparison with the JSDT statistics throughout the country, the proportion was very high among our patients.
The proportion of deaths due to infections was relatively high during the first year of dialysis, although it was very small among the patients who survived more than 5 years. Of the 11 patients who began hemodialysis at the age of 50 years or greater and who died of infection, 6 died of tuberculosis.
Sudden deaths accounted for 30% of the deaths in those patients who were on maintenance hemodialysis for more than 5 years.
These findings emphasize the increasing importance of the prevention of cerebro-vascular accidents (especially cerebral hemorrhage) and sudden death in patients who survive more than 5 years of hemodialysis therapy.

Echocardiography was performed in two gruops of patients with impaired renal function excluding those with diabetic renal failure. Group A was comprised of 19 patients who had recieved hemodialysis from 1 year to 5 years, and Group B, of 32 patients who had been undergoing hemodialysis for more than 10 years. Significant reductions in left ventricular diastolic dimensions and cardiac output were found in Group B. In these two groups, there were no statistically significant differences in left ventricular wall thickness and left ventricular ejection fraction. Left ventricular diastolic function was assessd by the ratio of the peak atrial velosity (A) to early diastolic velosity (E). 15 patients (83%) in Group A and 19 patients (76%) in Group B had left ventricular diastolic dysfunction. A high incidence of left ventricular diastolic dysfunction was revealed. Moreover, dilated and hypertrophic cardiomyopathy like patterns were observed in both groups. In Group B, significantly increased left ventricular wall thickness in patients with hypertension and reduced left ventricular systolic function in patients with dialysis hypotension were found.

The number of patients with diabetes mellitus (DM) in Japan is increasing. Progression of DM leads to the development of diabetic peripheral neuropathy, which causes foot sensory disturbances. This study examined the effect of DM on plantar tactile point pressure sensitivity (TPPS) and identified the site with the highest threshold of plantar TPPS. The subjects were 42 DM patients (aged 71.7±8.2 years) and 122 local elderly residents (aged 72.6±4.8 years). TPPS of eight sites, including the right and left halluces, hallux and fifth toe metatarsal heads, and heels was measured using the Semmes-Weinstein monofilament test. The measurement was performed three times at each site. The results were adopted when all repeated measurements were valid. The Friedman test was used for comparison among the four sites within the same group. The Mann-Whitney U test was used for comparison of sites between groups. A significance level of 5% was adopted. The ages of the DM patients were not significantly different, but the patients had significantly higher TPPS threshold for halluces, and hallux and fifth toe metatarsal heads, compared to the local elderly residents. The TPPS threshold was highest in the heels in both the DM patients and local elderly residents. The threshold of plantar TPPS increases in DM. It is important to evaluate both the forefoot and the heels.