Background Because patients on maintenance hemodialysis (HD) have an impaired immune response to pathogens, they are at higher risk of severe coronavirus disease 2019 (COVID-19). However, data on antibody production among HD patients with COVID-19 is scarce. Thus, we performed a retrospective cohort study evaluating severe acute respiratory syndrome coronavirus two antibody (SARS-CoV-2) production within 1 month after COVID-19 onset in hospitalized patients on HD. Methods SARS-CoV-2-specific immunoglobulin (Ig) G levels were quantified using an iFlash 3000 Chemiluminescence Immunoassay analyzer (Shenzhen YHLO Biotech Co., Ltd.) to detect IgG antibodies specific for the S1 subunit of the spike protein (IgG-S1). Propensity score matching was used to balance covariate distribution in HD and non-HD patients. From April 2020 to February 2021, antibody testing was performed on 161 hospitalized patients with symptomatic COVID-19. Of them, 34 HD patients were matched to 68 non-HD patients. Results After propensity score matching, the median levels of IgG-S1 in the HD patients at 7–13 days after symptom onset were significantly lower than in non-HD patients, especially in those with severe disease. Among all patients, those with severe disease produced lower levels of IgG-S1 at 7–13 days compared with non-severe patients. Conclusion COVID-19 patients with severe disease, especially those undergoing HD, had lower IgG-S1 production in the second week of the disease. Thus, the increased risk of severe COVID-19 in HD patients may be, in part, due to a slow and reduced antibody response.

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Charcot’s triad, consisting of high fever, abdominal pain, and jaundice, is a well-known clinical feature of acute cholangitis. However, some patients, especially elderly patients, are asymptomatic. We reported herein a case of acute cholangitis in an elderly patient on hemodialysis who was asymptomatic, but whose cholangitis was discovered when a yellow discoloration of her dialyzer was noticed. Blood tests and imaging studies should be performed as soon as possible after noticing yellowish discoloration of dialyzer fibers because asymptomatic acute cholangitis may be present.