High Prevalence of Asymptomatic COVID-19 Infection in Hemodialysis Patients Detected Using Serologic Screening

Abstract

BackgroundStrategies to minimize the risk of transmission and acquisition of COVID-19 infection in patients with ESKD receiving in-center hemodialysis have been rapidly implemented across the globe. Despite these interventions, confirmed COVID-19 infection rates have been high in the United Kingdom. Prevalence of asymptomatic disease in an adult hemodialysis population has not been reported. Also, to our knowledge, the development of humoral response to SARS-CoV-2 has not been previously reported in this population. Although serologic testing does not provide information on the infectivity of patients, seroprevalence studies may enable investigation of exposure within dialysis units and hence, assessment of current screening strategies.MethodsTo investigate the seroprevalence of SARS-CoV-2 antibodies in a hemodialysis population, we used the Abbott IgG assay with the Architect system to test serum samples from 356 patients receiving in-center hemodialysis for SARS-CoV-2 antibodies.ResultsOf 356 patients, 121 had been symptomatic when screened before a dialysis session and received an RT-PCR test; 79 (22.2% of the total study population) tested positive for COVID-19. Serologic testing of all 356 patients found 129 (36.2%) who tested positive for SARS-CoV-2 antibodies. Only two patients with PCR-confirmed infection did not seroconvert. Of the 129 patients with SARS-CoV-2 antibodies, 52 (40.3%) had asymptomatic disease or undetected disease by PCR testing alone.ConclusionsWe found a high seroprevalence of SARS-CoV-2 antibodies in patients receiving in-center hemodialysis. Serologic evidence of previous infection in asymptomatic or PCR-negative patients suggests that current diagnostic screening strategies may be limited in their ability to detect acute infection.

Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications

“…Nonetheless, the seroprevalence within this group may be markedly different from that of the general population. For example, a study of U.K. dialysis patients found seroprevalence of about 36%, several times higher than that obtained using a very large random sample of the English population [21,22]. Similarly, a recent U.S. study found a seropositive rate of 34% for dialysis patients in New York state that was more than twice as high as the seroprevalence in a random sample of New York residents [10,23 Our critical review has also underscored the pitfalls of seroprevalence studies based on "convenience samples" of residual sera collected for other purposes.…”

Large-scale IgM and IgG SARS-CoV-2 serological screening among healthcare workers with a low infection prevalence based on nasopharyngeal swab tests in an Italian university hospital: Perspectives for public health

“…In a multicenter retrospective study in Wuhan, China, 47% of SARS-CoV-2-infected people, who were mostly asymptomatic, were diagnosed with serological tests after negative RT-PCR ( Tang et al, 2020 ), as demonstrated by Clarke and colleagues. A high seroprevalence of SARS-CoV-2 antibodies was noted in asymptomatic or PCR-negative patients receiving in-center hemodialysis, suggesting that current diagnostic screening strategies may be limited in their ability to detect acute infection ( Clarke et al, 2020 ). In our study, we found a high seroprevalence of SARS-CoV-2 with the Abbott test, but low sensitivity in identifying virus carriers and low positive predictive values in 2407 serum samples.…”

Coronavirus Disease 2019 in Patients With End-Stage Kidney Disease on Hemodialysis in Guatemala

“…21 Interestingly, a study addressing the seroprevalence of SARS-CoV-2 antibodies in a hemodialysis population in the United Kingdom found that around 36.2% of the patients tested positive for COVID-19 and almost half were asymptomatic. 32 …”