scholarly journals Vaccine optimization for COVID-19: Who to vaccinate first?

2020 ◽  
Vol 7 (6) ◽  
pp. eabf1374
Author(s):  
Laura Matrajt ◽  
Julia Eaton ◽  
Tiffany Leung ◽  
Elizabeth R. Brown
Keyword(s):  
Mathematical Model ◽  
High Risk ◽  
Vaccination Coverage ◽  
Age Groups ◽  
Vaccine Effectiveness ◽  
Older Age ◽  
Evidence Based ◽  
Ethical Considerations ◽  
Younger Age ◽  
Vaccine Shortages

Vaccines, when available, will likely become our best tool to control the COVID-19 pandemic. Even in the most optimistic scenarios, vaccine shortages will likely occur. Using an age-stratified mathematical model paired with optimization algorithms, we determined optimal vaccine allocation for four different metrics (deaths, symptomatic infections, and maximum non-ICU and ICU hospitalizations) under many scenarios. We find that a vaccine with effectiveness ≥50% would be enough to substantially mitigate the ongoing pandemic, provided that a high percentage of the population is optimally vaccinated. When minimizing deaths, we find that for low vaccine effectiveness, irrespective of vaccination coverage, it is optimal to allocate vaccine to high-risk (older) age groups first. In contrast, for higher vaccine effectiveness, there is a switch to allocate vaccine to high-transmission (younger) age groups first for high vaccination coverage. While there are other societal and ethical considerations, this work can provide an evidence-based rationale for vaccine prioritization.

scholarly journals Vaccine optimization for COVID-19: who to vaccinate first?

2020 ◽  
Author(s):  
Laura Matrajt ◽  
Julie Eaton ◽  
Tiffany Leung ◽  
Elizabeth R Brown
Keyword(s):  
Mathematical Model ◽  
High Risk ◽  
Vaccination Coverage ◽  
Age Groups ◽  
Vaccine Effectiveness ◽  
Older Age ◽  
Evidence Based ◽  
Ethical Considerations ◽  
Younger Age ◽  
Vaccine Shortages

A vaccine, when available, will likely become our best tool to control the cur- rent COVID-19 pandemic. Even in the most optimistic scenarios, vaccine shortages will likely occur. Using an age-stratified mathematical model paired with optimization algorithms, we determined optimal vaccine allocation for four different metrics (deaths, symptomatic infections, and maximum non- ICU and ICU hospitalizations) under many scenarios. We find that a vaccine with effectiveness ≥50% would be enough to substantially mitigate the ongo- ing pandemic provided that a high percentage of the population is optimally vaccinated. When minimizing deaths, we find that for low vaccine effective- ness, irrespective of vaccination coverage, it is optimal to allocate vaccine to high-risk (older) age-groups first. In contrast, for higher vaccine effectiveness, there is a switch to allocate vaccine to high-transmission (younger) age-groups first for high vaccination coverage. While there are other societal and ethical considerations, this work can provide an evidence-based rationale for vaccine prioritization.

Prevalence of high-risk human papillomavirus in uterine cervical lesions among older Japanese women.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5084-5084
Author(s):  
Kazuhiro Takehara ◽  
Hiroko Nakamura ◽  
Osamu Samura ◽  
Tomoya Mizunoe ◽  
Akihisa Saito ◽  
...  
Keyword(s):  
High Risk ◽  
Age Groups ◽  
Hpv Infection ◽  
Japanese Women ◽  
Older Age ◽  
Age Group ◽  
Hpv 16 ◽  
Younger Age ◽  
Hpv Genotypes ◽  
High Risk Hpv

5084 Background: To estimate the prevalence and genotypes of high-risk human papillomavirus (HPV) among older Japanese women, using liquid-based cytology (LBC). Methods: ThinPrep LBC specimens were collected from 11,039 Japanese women (age range, 14-98 years). After classifying cytodiagnosis, specimens were analyzed for HPV DNA using the multiplex polymerase chain reaction method. Cervical smear specimens from 1,302 women showed positive results. To examine the prevalence of HPV in women defined as negative for intraepithelial lesion or malignancy (NILM), 2,563 samples were randomly selected from the remaining 9,737 women. Comparisons were made between women ≥50 years of age (older age group) and women <50 years of age (younger age group). Written informed consent was obtained from all patients. In this study, the high-risk HPV genotypes encountered were 16, 18, 31, 33, 35, 45, 52, and 58. Results: In the older age group with abnormal smear findings, HPV genotypes were detected in 49.7% (148/298), including high-risk HPV genotypes in 40.9% (122/298). In the younger age group with abnormal smear findings, HPV genotypes were detected in 71.7% (720/1004), including high-risk HPV genotypes in 58.1% (583/1,004). In NILM, HPV-positive rates were 4.5% (39/873) in the older age group and 11.8% (199/1,690) in the younger age group. In high-grade squamous intraepithelial lesion (HSIL) or more severe cytological findings, HPV genotypes of each group (older age group/younger age group) were detected in 61.7%/83.1%, and high-risk HPV genotypes were detected in 56.4%/74.7% of women. In positive cervical smears, HPV 16 was the most frequently detected (28.5%) in the younger age group, while HPV 52 (31.3%) and 58 (27.2%) were detected more frequently than HPV 16 (18.4%) in the older age group. Conclusions: In Japan, although HPV infection as a cause of abnormal cervical cytology is more frequent among younger age groups than in older age groups, high-risk HPV infection was more highly associated with older individuals (older age group/younger age group: abnormal smear findings, 82.4%/81.0%; HSIL or more severe cytological findings, 91.3%/89.9%). In older age groups, HPV 52 and 58 were more frequent than HPV 16.

scholarly journals Japan’s voluntary lockdown: further evidence based on age-specific mobile location data

2021 ◽  
Author(s):  
Tsutomu Watanabe ◽  
Tomoyoshi Yabu
Keyword(s):  
Age Groups ◽  
Evidence Based ◽  
Intervention Effect ◽  
Information Effect ◽  
Mobile Location ◽  
Serious Illness ◽  
Location Data ◽  
Voluntary Response ◽  
Younger Age ◽  
Age Profile

AbstractChanges in people’s behavior during the COVID-19 pandemic can be regarded as the result of two types of effects: the “intervention effect” (changes resulting from government orders for people to change their behavior) and the “information effect” (voluntary changes in people’s behavior based on information about the pandemic). Using age-specific mobile location data, we examine how the intervention and information effects differ across age groups. Our main findings are as follows. First, the age profile of the intervention effect shows that the degree to which people refrained from going out was smaller for older age groups, who are at a higher risk of serious illness and death, than for younger age groups. Second, the age profile of the information effect shows that the degree to which people stayed at home tended to increase with age for weekends and holidays. Thus, while Acemoglu et al. (2020) proposed targeted lockdowns requiring stricter lockdown policies for the oldest group in order to protect those at a high risk of serious illness and death, our findings suggest that Japan’s government intervention had a very different effect in that it primarily reduced outings by the young, and what led to the quarantining of older groups at higher risk instead was people’s voluntary response to information about the pandemic. Third, the information effect has been on a downward trend since the summer of 2020. It is relatively more pronounced among the young, so that the age profile of the information effect remains upward sloping.

scholarly journals Aging Reduces EEG Markers of Recognition Despite Intact Performance: Implications for Forensic Memory Detection

2020 ◽  
Author(s):  
Robin Hellerstedt ◽  
Arianna Moccia ◽  
Chloe M. Brunskill ◽  
Howard Bowman ◽  
Zara M. Bergström
Keyword(s):  
Older Adults ◽  
Temporal Variability ◽  
Brain Activity ◽  
Age Groups ◽  
Older Age ◽  
Practical Applications ◽  
Younger Age ◽  
Behavioural Performance ◽  
Older Populations

AbstractERP-based forensic memory detection is based on the logic that guilty suspects will hold incriminating knowledge about crimes they have committed, and therefore should show parietal ERP positivities related to recognition when presented with reminders of their crimes. We predicted that such forensic memory detection might however be inaccurate in older adults, because of changes to recognition-related brain activity that occurs with aging. We measured both ERPs and EEG oscillations associated with episodic old/new recognition and forensic memory detection in 30 younger (age < 30) and 30 older (age > 65) adults. EEG oscillations were included as a complementary measure which is less sensitive to temporal variability and component overlap than ERPs. In line with predictions, recognition-related parietal ERP positivities were significantly reduced in the older compared to younger group in both tasks, despite highly similar behavioural performance. We also observed ageing-related reductions in oscillatory markers of recognition in the forensic memory detection test, while the oscillatory effects associated with episodic recognition were similar across age groups. This pattern of results suggests that while both forensic memory detection and episodic recognition are accompanied by ageing-induced reductions in parietal ERP positivities, these reductions may be caused by non-overlapping mechanisms across the two tasks. Our findings suggest that EEG-based forensic memory detection tests are invalid in older populations, limiting their practical applications.

scholarly journals Comparison of anthropometric data quality in children aged 6-23 and 24-59 months: lessons from population-representative surveys from humanitarian settings

BMC Nutrition ◽  
2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Oleg Bilukha ◽  
Alexia Couture ◽  
Kelly McCain ◽  
Eva Leidman
Keyword(s):  
Data Quality ◽  
Age Groups ◽  
Older Age ◽  
Demographic And Health Surveys ◽  
Age Group ◽  
Anthropometric Data ◽  
Digit Preference ◽  
Anthropometric Indicators ◽  
Younger Age

Abstract Background Ensuring the quality of anthropometry data is paramount for getting accurate estimates of malnutrition prevalence among children aged 6–59 months in humanitarian and refugee settings. Previous reports based on data from Demographic and Health Surveys suggested systematic differences in anthropometric data quality between the younger and older groups of preschool children. Methods We analyzed 712 anthropometric population-representative field surveys from humanitarian and refugee settings conducted during 2011–2018. We examined and compared the quality of five anthropometric indicators in children aged 6–23 months and children aged 24–59 months: weight for height, weight for age, height for age, body mass index for age and mid-upper arm circumference (MUAC) for age. Using the z-score distribution of each indicator, we calculated the following parameters: standard deviation (SD), percentage of outliers, and measures of distribution normality. We also examined and compared the quality of height, weight, MUAC and age measurements using missing data and rounding criteria. Results Both SD and percentage of flags were significantly smaller on average in older than in younger age group for all five anthropometric indicators. Differences in SD between age groups did not change meaningfully depending on overall survey quality or on the quality of age ascertainment. Over 50% of surveys overall did not deviate significantly from normality. The percentage of non-normal surveys was higher in older than in the younger age groups. Digit preference score for weight, height and MUAC was slightly higher in younger age group, and for age slightly higher in the older age group. Children with reported exact date of birth (DOB) had much lower digit preference for age than those without exact DOB. SD, percentage flags and digit preference scores were positively correlated between the two age groups at the survey level, such as those surveys showing higher anthropometry data quality in younger age group also tended to show higher quality in older age group. Conclusions There should be an emphasis on increased rigor of training survey measurers in taking anthropometric measurements in the youngest children. Standardization test, a mandatory component of the pre-survey measurer training and evaluation, of 10 children should include at least 4–5 children below 2 years of age.

Biologic Features and Clinical Outcomes According to Age Groups In Myelodysplastic Syndrome

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4963-4963
Author(s):  
Seungbum Lee ◽  
Je-Hwan Lee ◽  
Jung-Hee Lee ◽  
Dae-Young Kim ◽  
Sung-Doo Kim ◽  
...  
Keyword(s):  
High Risk ◽  
Prognostic Factor ◽  
Myelodysplastic Syndrome ◽  
Clinical Outcomes ◽  
Survival Data ◽  
Risk Group ◽  
Age Groups ◽  
Intensive Treatment ◽  
Age Group ◽  
Younger Age

Abstract Abstract 4963 Myelodysplastic syndrome (MDS) is a disease of the elderly, but can also affect younger people. Age is known to be an important prognostic factor in MDS but age variable is not included in most prognostic scoring systems because it is not thought as a disease-related variable. Many reports have showed that MDS is seen one to two decades earlier in Far Eastern countries than Western countries. We retrospectively investigated the differences in biologic features and clinical outcomes according to different age groups in Korean patients with MDS. Primary end points of our study were overall survival (OS) and progression-free survival (PFS). PFS was defined as time from diagnosis to AML progression or death. About one third of the patients received intensive treatment including chemotherapy, hypomethylating treatment or hematopoietic cell transplantation. Therefore, all survival data were censored at the start of intensive treatment to eliminate the influence of the treatments on clinical outcomes. A total of 403 patients, 248 males and 155 females, were included in this study. Median age was 54 years. We divided the patients into three age groups: ≤50 years (n=181), 51 to 60 (n=81), and over 60 (n=141). Baseline biologic features were significantly different according to three age groups: with increasing age, more male preponderance (P=0.009), more BM blast percentage (P<0.001), more advanced WHO subtype (P<0.001), higher proportion of high risk cytogenetic features (P=0.052; ≤60 vs. >60, P=0.011), poorer ECOG performance status (P=0.004), higher IPSS risk group (P=0.019). Five-year survival probabilities were significantly different according to age groups (≤ 50 vs. 51–60 vs. > 60; OS, 66.8% vs. 28.5% vs. 12.2%, P<0001; PFS, 58.5% vs. 37.9% vs. 12.3%, P<0.001). Survivals were also significantly different according to age groups in both IPSS Low/INT-1 (P<0.001 for OS, P=0.001 for PFS) and IPSS INT-2/High risk group (P=0.026 for OS, P=0.069 for PFS). Cox proportional hazards models also demonstrated that age group was an independent prognostic factor for survivals: ≤ 50 vs. 51–60 and > 60; OS, RR 2.3 (P=0.037) and RR 4.6 (P<0.001); PFS, RR 1.3 (P=0.449) and RR 2.0 (P=0.012). Conclusion: Biologic features and clinical outcomes were significantly different among age groups in MDS. Clinical outcomes were better in younger age group independently of biologic features. Survivals (OS & PFS) were better in younger age group and survival differences by age groups were observed in both lower and higher risk MDS, suggesting that age stratification should be considered in treatment decision and clinical trial design. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Younger ages at risk of Covid-19 mortality in communities of color

2020 ◽  
Vol 4 ◽  
pp. 69 ◽  
Author(s):  
Keith P. Klugman ◽  
Solomon Zewdu ◽  
Barbara E. Mahon ◽  
Scott F. Dowell ◽  
Padmini Srikantiah ◽  
...  
Keyword(s):  
South Africa ◽  
High Risk ◽  
Age Groups ◽  
Risk Groups ◽  
Minority Communities ◽  
Communities Of Color ◽  
Younger Age ◽  
Disaggregated Data ◽  
The Uk ◽  
Selection Of

More than 85% of Covid-19 mortality in high income countries is among people 65 years of age or older. Recent disaggregated data from the UK and US show that minority communities have increased mortality among younger age groups and in South Africa initial data suggest that the majority of deaths from Covid-19 are under 65 years of age. These observations suggest significant potential for increased Covid-19 mortality among younger populations in Africa and South Asia and may impact age-based selection of high-risk groups eligible for a future vaccine.

scholarly journals Errata ao artigo “Estimativa do Excesso de Mortalidade Durante a Pandemia COVID-19: Dados Preliminares Portugueses”, publicado em Acta Med Port 2020 Jun;33(6):376-383

2020 ◽  
Vol 33 (6) ◽  
pp. 450
Author(s):  
Paulo Jorge Nogueira ◽  
Miguel De Araújo Nobre ◽  
Paulo Jorge Nicola ◽  
Cristina Furtado ◽  
António Vaz Carneiro
Keyword(s):  
Protective Effect ◽  
Excess Mortality ◽  
Age Groups ◽  
Older Age ◽  
Younger Age ◽  
Summer Holiday ◽  
Overall Mortality

Article published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13928On page 376, in Abstract, paragraph Results, where it reads: ”Despite the inherent uncertainty, it is safe to assume an observed excess mortality of 2400 to 4000 deaths. Excess mortality was associated with older age groups (over age 65).”It should read: “An excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65).”On page 376, in Abstract, paragraph Conclusion, where it reads: ”The excess mortality occurred between March 1 and April 22 was 3 to 5 fold higher than what can be explained by the official COVID-19 deaths.”It should read: “Despite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths.”On page 376, in Resumo, paragraph Conclusão, where it reads: “Da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril foi 3 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”It should read: “Apesar da incerteza inerente, da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril poderá ter sido 3,5 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”On page 377, last line of the first paragraph, where it reads: “If the lockdown had some protective effect on overall mortality, like summer holiday months seem to have, these effects may be observed some, if not all, age groups.”It should read: “If the lockdown had some protective effect on overall mortality, like summer holiday months seem to have, these effects may be observed in all age groups.”On page 377, section Results, third paragraph, last sentence where it reads: “Mortality in the younger age groups was, on average, below the proposed baselines, as hypothesized.”It should read: “Mortality in the younger age groups was, on average, lower than the proposed baselines as theorized.”On page 382, section Conclusion, last sentence, where it reads: “Overall, these results point towards an excess mortality that is associated with and that is 3 to 5-fold higher than the official COVID-19 mortality.” It should read: “Overall, these results point towards an excess mortality that is associated with and that could be 3.5- to 5-fold higher than the official COVID-19 mortality.” Artigo publicado com erros: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13928Na página 376, no Abstract, parágrafo Results, onde se lê: “Despite the inherent uncertainty, it is safe to assume an observed excess mortality of 2400 to 4000 deaths. Excess mortality was associated with older age groups (over age 65).”Deverá ler-se: “An excess mortality of 2400 to 4000 deaths was observed. Excess mortality was associated with older age groups (over age 65).”Na página 376, no Abstract, parágrafo Conclusion, onde se lê: “The excess mortality occurred between March 1 and April 22 was 3 to 5 fold higher than what can be explained by the official COVID-19 deaths."Deverá ler-se: “Despite the inherent uncertainty, the excess mortality occurred between March 1 and April 22 could be 3.5- to 5-fold higher than what can be explained by the official COVID-19 deaths.”Na página 376, no Resumo, parágrafo Conclusão, onde se lê: “Da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril foi 3 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”Deverá ler-se: “Apesar da incerteza inerente, da análise dos resultados é possível concluir que o excesso de mortalidade ocorrido entre 1 de março e 22 de abril poderá ter sido 3,5 a 5 vezes superior ao explicado pelas mortes por COVID-19 reportadas oficialmente.”Na página 377, na última linha do primeiro parágrafo, onde se lê: “If the lockdown had some protective effect on overall mortality, like summer holiday months seem to have, these effects may be observed some, if not all, age groups.”Deverá ler-se: “If the lockdown had some protective effect onoverall mortality, like summer holiday months seem to have, these effects may be observed in all age groups.”Na página 377, secção Resultados, terceiro parágrafo última frase, onde se lê: “Mortality in the younger age groups was, on average, below the proposed baselines, as hypothesized.”Deverá ler-se: “Mortality in the younger age groups was, on average, lower than the proposed baselines as theorized.”Na página 382, secção Conclusion, última frase, onde se lê: “Overall, these results point towards an excess mortality that is associated with and that is 3 to 5-fold higher than the official COVID-19 mortality.”Deverá ler-se: “Overall, these results point towards an excess mortality that is associated with and that could be 3.5- to 5-fold higher than the official COVID-19 mortality.”

Abstract 31: Cardiovascular Health at Young and Middle Ages and Dementia in Older Age - The Chicago Heart Association Detection Project in Industry Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Thanh Huyen T Vu ◽  
Donald M Lloyd-Jones ◽  
Cuiping Schiman ◽  
Lei Liu ◽  
Lihui Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cardiovascular Health ◽  
Heart Association ◽  
Later Life ◽  
Older Age ◽  
Dementia Diagnosis ◽  
High Risk Factors ◽  
Industry Study ◽  
Younger Age

Background: Data are sparse regarding the association of cardiovascular health (CVH) in younger/middle age with the diagnosis of dementia later in life. Methods: We used linked data from the Chicago Heart Association Detection Project in Industry Study assessed in 1967-73 with fee-for-service Medicare claims and National Death Index data from 1991-2010. Participants were ≤65 years old in 1991 and Medicare eligible during 1991-2010. Baseline CVD risk factors included blood pressure, cholesterol, BMI, smoking, and diabetes. Participants were classified into four strata: favorable levels of all factors, 0 factors high but 1+ elevated, 1 high, and ≥2 high risk factors. ICD-9 codes were used to identify date of first dementia diagnosis. We used competing Cox models to estimate hazards for dementia in Medicare data after age 65 with competing event of all-cause mortality prior to dementia diagnosis. Covariates included baseline age, race, sex, and education attainment. Results: This study included 4,273 females and 8,381 males, 10.3% Black, baseline ages 18-48. Dementia was diagnosed in 5.1% of study participants. The prevalence of dementia diagnosis increased with increasing CVH burden from 3.4% to 6.4%. During 1991-2010 in Medicare, the average time from age 65 to the first dementia diagnosis was 7.7 years. Greater CVH in younger age was associated with a reduced risk of being diagnosed with dementia in later life. Hazards ratios of experiencing dementia in those with baseline favorable levels, 0 RF high, and 1 only high RF were lower by 36%, 29%, and 28% respectively as compared to those with 2+ high-risk factors (see Table - Model 1). Similar trends were observed when deaths were treated as competing events although the association was attenuated (Model 2). Patterns were similar when stratified by sex or race. Conclusions: Having a favorable CVH profile at younger age is associated with lower risk of dementia in older age. Improvements in CVH in younger age may translate to increased independence and quality of life later in life.

scholarly journals The Effect of Serum Sodium on Survival in Patients Treated by Peritoneal Dialysis in the United Kingdom

2017 ◽  
Vol 37 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Asmaa Al-Chidadi ◽  
Dorothea Nitsch ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Sodium ◽  
Cox Regression ◽  
Strong Association ◽  
Age Groups ◽  
Older Age ◽  
Age Group ◽  
Younger Age ◽  
Increased Risk ◽  
The Uk

Background Studies in hemodialysis patients suggest that hyponatremia is associated with increased mortality. However, results from peritoneal dialysis (PD) patients are discordant. We wished to establish whether there was an association between serum sodium and mortality risk in PD patients. Methods We analyzed 3,108 PD patients enrolled at day 90 of renal replacement therapy (RRT) into the UK Renal Registry (UKRR) data base with available serum sodium measurements (in 3 groups: ≤ 137, 138 - 140, ≥ 141 mmol/L) who were then followed up until death or the censoring date (31 December 2012). Analysis used Cox-regression with adjustment for age, sex, year of starting RRT, primary renal disease, serum albumin, smoking, and comorbidities. Results Unadjusted mortality rates were 118.6/1,000 person-years (py), 83.4/1,000 py, and 83.5/1,000 py for the lowest, middle, and highest serum sodium tertiles, respectively. After adjustment for covariates, patients in the lowest serum sodium group had almost 50% increased risk of dying compared with those with the highest serum sodium (hazard ratio [HR] 1.49, confidence interval [CI]:1.28 - 1.74), with a graded association between serum sodium and mortality. The association of serum sodium with mortality varied by age (p interaction < 0.001), and whilst this association attenuated after adjustment for confounding variables in the older age groups (55 - 64, and > 65 years), it remained in the younger age group of 18 - 54 years (HR 2.24 [1.36 – 3.70] in the lowest compared with the highest sodium tertile). Conclusions Lower serum sodium concentrations at the start of RRT in PD patients are associated with increased risk of mortality. Whilst this association may well be due to confounding in the older age groups, the persistent strong association between hyponatremia and mortality in the younger age group after adjustment for the available confounders suggests that prospective studies are required to assess whether active intervention to maintain serum sodium changes outcomes.

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