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The usual cause of death for patients with amyotrophic lateral sclerosis (ALS) is respiratory failure from progressive muscle weakness. ALS is a neurodegenerative condition that primarily affects motor neurons, leading to a gradual decline in muscle strength and control. As the disease progresses, the muscles that control breathing become weakened, severely impairing the patient's ability to inhale and exhale effectively.

Respiratory failure occurs when the respiratory muscles can no longer function adequately to maintain normal oxygen and carbon dioxide levels in the body. This failure is often compounded by the fact that individuals with ALS may also experience difficulties swallowing, increasing the risk of aspiration pneumonia and further respiratory complications. Thus, patients commonly die from the inability to breathe properly due to muscle deterioration.

While cardiac arrest, sepsis, and kidney failure can occur in any patient due to various reasons, they are not the primary complications associated with ALS progression. The pathophysiology of ALS specifically targets motor functions, making respiratory failure the leading cause of death in this population.