Death from dialysis termination among Italian diabetic patients treated by renal replacement therapy

In North America and Australia deaths from suicide and dialysis termination (social causes of death) are very frequent among patients treated by Renal Replacement Therapy, and diabetes is the major pathology associated with this type of death. Few data are available for Europe. In the present paper we have investigated the frequency of suicide and dialysis termination among diabetic patients starting RRT in Italy in 1987 (incident group) and among those diabetic patients who were alive on RRT by December 31, 1987 (prevalent group). We also investigated a prevalent control group of nondiabetic patients similar to the prevalent diabetic group according to sex, age, year of starting and first type of RRT. These 3 groups were followed up to December 31, 1991. In 1987, 524 diabetic patients started RRT and 305 of these died during follow-up. Three (1.1% of the known causes of death) died because of suicide or dialysis termination. By December 31, 1987, 1605 diabetic patients were alive on RRT treatment in Italy and we were able to match and follow-up 1576 of them. By December 31, 1991, 58% of the diabetic and 39% of the nondiabetic patients had died (p < 0.001). The proportion of patients deceased because of suicide and dialysis discontinuation was very low in both groups (0.5% and 0.8% of the known causes of death, respectively, p = ns). Logistic regression analysis showed that only old age was significantly associated with dialysis termination, while sex, type of treatment, and presence of diabetes were not associated with discontinuation of dialysis. Our data show that death from social causes is very rare among Italian patients treated by Renal Replacement Therapy, and that diabetes is not associated with dialysis termination.