Prolonged Live SARS-CoV-2 Shedding in a Maintenance Dialysis Patient

Lacson, Eduardo; Weiner, Daniel E.; Majchrzak, Karen M.; Puryear, Wendy B.; Hosford, John; Palmer, Aaron Zeff; Runstadler, Jonathan A.; Meyer, Klemens B.; Johnson, Dianna A.

doi:10.1016/j.xkme.2020.12.001

Cited by 8 publications

(12 citation statements)

References 6 publications

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“…These findings are consistent with other publications specific to the outpatient dialysis population (4 –6,11) that illustrate the frequency of persistently positive RT-PCR results after recovery and highlight the challenge of using RT-PCRs as a marker of infectivity. Small observational studies involving patients with ESKD on maintenance dialysis with SARS-CoV-2 infection reported persistent viral RNA detected by RT-PCR 19–40 days from an initial positive test (5,6,11).…”

Section: Discussionsupporting

confidence: 91%

“…Small observational studies involving patients with ESKD on maintenance dialysis with SARS-CoV-2 infection reported persistent viral RNA detected by RT-PCR 19–40 days from an initial positive test (5,6,11). However, to our knowledge, only Lacson et al (4) performed viral culture to assess infectivity. In 45 specimens with positive SARS-CoV-2 molecular tests from 29 patients on in-center hemodialysis who were followed weekly after diagnosis, only two patients had positive viral cultures (4).…”

Section: Discussionmentioning

confidence: 99%

“…Case series have documented that patients with ESKD on maintenance dialysis diagnosed with SARS-CoV-2 infection can have persistently or intermittently positive SARS-CoV-2 real-time RT-PCR tests after recovery, but the significance of these findings is not well understood (4)(5)(6). In other populations, the significance of persistently positive RT-PCR results and the duration of shedding viable (i.e., infectious) virus has been described (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis

et al. 2021

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BackgroundPatients with ESKD on maintenance dialysis receive dialysis in common spaces with other patients and have a higher risk of severe SARS-CoV-2 infections. They may have persistently or intermittently positive SARS-CoV-2 RT-PCR tests after infection. We describe the clinical course of SARS-CoV-2 infection and the serologic response in a convenience sample of patients with ESKD to understand the duration of infectivity.MethodsFrom August to November 2020, we enrolled patients on maintenance dialysis with SARS-CoV-2 infections from outpatient dialysis facilities in Atlanta, Georgia. We followed participants for approximately 42 days. We assessed COVID-19 symptoms and collected specimens. Oropharyngeal (OP), anterior nasal (AN), and saliva (SA) specimens were tested for the presence of SARS-CoV-2 RNA, using RT-PCR, and sent for viral culture. Serology, including neutralizing antibodies, was measured in blood specimens.ResultsFifteen participants, with a median age of 58 (range, 37‒77) years, were enrolled. Median duration of RT-PCR positivity from diagnosis was 18 days (interquartile range [IQR], 8‒24 days). Ten participants had at least one, for a total of 41, positive RT-PCR specimens ≥10 days after symptoms onset. Of these 41 specimens, 21 underwent viral culture; one (5%) was positive 14 days after symptom onset. Thirteen participants developed SARS-CoV-2–specific antibodies, 11 of which included neutralizing antibodies. RT-PCRs remained positive after seroconversion in eight participants and after detection of neutralizing antibodies in four participants; however, all of these samples were culture negative.ConclusionsPatients with ESKD on maintenance dialysis remained persistently and intermittently SARS-CoV-2–RT-PCR positive. However, of the 15 participants, only one had infectious virus, on day 14 after symptom onset. Most participants mounted an antibody response, including neutralizing antibodies. Participants continued having RT-PCR–positive results in the presence of SARS-CoV-2–specific antibodies, but without replication-competent virus detected.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis

et al. 2021

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“…It may explain some observations describing poor vaccine response (e.g. Hepatitis B virus, not limited to SARS-CoV-2) [6], faster waning of antibodies [13], decreased ability to clear the virus [14], and higher rates of COVID-related death in this high risk population as observed in this study. Furthermore, current recommendations are that specific immunocompromised populations routinely receive additional doses [15]; it is unknown whether specific subgroups of dialysis patients could benefit from a similar response and mitigate number of and/or increased severity of infections in vaccinated patients on dialysis.…”

supporting

confidence: 53%

SARS-CoV-2 Infections among Vaccinated Patients on Maintenance Dialysis, January 1–August 31, 2021, United States

et al. 2022

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“…Beyond the surge of cases and the infrastructure limits of the dialysis units, the prolonged viral shedding measured by RT-PCR on nasopharyngeal swabs is appraised as a further cause of workplace stress because it tends to increase the cumulative number of cases requiring quarantine [ 2 ].…”

mentioning

confidence: 99%

Which criteria should we use to end isolation in hemodialysis patients with COVID-19?

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Morisi

et al. 2022

Clinical Kidney Journal

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Safe and timely discontinuation of quarantine of in-center hemodialysis (HD) patients with a previous SARS-CoV-2 infection is a challenging issue for the nephrological community because current guidelines for ending isolation do not mention dialysis patients. To prevent potentially fatal outbreaks of COVID-19, a cautionary approach has been adopted by most dialysis units. The criteria for ending the isolation in the HD population generally coincide with those recommended for immunocompromised people. Thus, a test-based strategy relying on two consecutive negative reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs has been adopted to terminate quarantine. This strategy has the disadvantage to prolong isolation as RT-PCR positivity does not equate to SARS-CoV-2 infectivity. Consequentially, prolonged positivity of SARS-CoV-2 results in excessive workload for the HD staff who must face an increasing number of COVID-19 patients requiring isolation. This condition leads also to serious implications for the patients and their households including work productivity loss, postponement of health care appointments and an increased risk of COVID-19 reinfection. To counteract this problem other diagnostic tests should be used to provide the best care to HD patients. Recent results seem to encourage the use of RT-PCR cycle threshold (Ct) values and antigenic tests given their better correlation with cell culture for SARS-CoV-2 than RT-PCR testing. Here, we provide an overview of the current scientific evidence on the tests used to verify the infectiousness of the virus in order to stimulate the nephrological community to adopt a streamlined and pragmatic procedure to end isolation in COVID-19 patients on HD.

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Prolonged Live SARS-CoV-2 Shedding in a Maintenance Dialysis Patient

Abstract: Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

Cited by 8 publications

References 6 publications

Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis

Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis

SARS-CoV-2 Infections among Vaccinated Patients on Maintenance Dialysis, January 1–August 31, 2021, United States

Which criteria should we use to end isolation in hemodialysis patients with COVID-19?

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