Serologic Detection of SARS-CoV-2 Infections in Hemodialysis Centers: A Multicenter Retrospective Study in Wuhan, China

Abstract

Patients receiving maintenance hemodialysis (MHD) are highly vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current study was designed to evaluate the prevalence of SARS-CoV-2 infection based on both nucleic acid testing (NAT) and antibody testing in Chinese patients receiving MHD.

Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients

“…In this series, fatigue and anorexia were the most common symptoms among HD-infected patients [18]. In addition, 25% of infected patients confirmed by nucleic acid test and 79% of those identified by serologic testing were asymptomatic during the whole clinical course [21]. Further large prospective studies, including different ethnicities, should be conducted to inform risk stratification with the ultimate goal of improving the outcome of HD patients with COVID-19 infection.…”

“…However, most studies have reported less severe clinical symptoms in HD patients compared with the general population [13,19,20,36]. In a Chinese series, the most common symptoms were fever, cough, and bilateral ground-glass or patchy opacity of the lungs [21]. However, a retrospective Chinese study comparing 49 HD vs. 52 non-renal failure patients having similar baseline characteristics found that fever, fatigue, and dry cough were more predominant in controls but less frequent in HD infected patients.…”

“…Asian countries adopted universal screening using a nucleic acid test, serology, or computed tomography. The serologic antibody response is detectable 7 to 10 days or later after the onset of symptoms of COVID-infection in the general population [42]; however, the humoral response may extend from 14 to 55 days in HD patients [21]. By contrast, non-Asian countries, except for Canada [14], conducted viral screening only in symptomatic patients or patients at high risk of exposure, using mainly the nucleic acid test.…”

COVID-19 Antibodies and Outcomes among Outpatient Maintenance Hemodialysis Patients

“…This is compatible with studies from China and England which reported an asymptomatic rate between 21-51% among maintenance hemodialysis patients. 7,13,14 Using serological testing, the overall prevalence of COVID-19 of 28.3% in these three dialysis units is significantly higher than results from a Chinese study reporting a seroprevalence rate of 9.6%, 13 but less than that from a study from England which had a seroprevalence rate of 36.3%. 14 Nearly half our symptomatic patients went on to be hospitalized, which is much higher than hospitalization rates observed in the general population, which vary by age, but is similar to the hospitalization rates described among residents of a Washington state long-term care facility.…”

“…Reports from outpatient dialysis units in China and England using serological testing found rates of asymptomatic infection of 51% and 40%, respectively. 13,14 These studies have been limited by restricted demographics and comorbidities, utilization of data from community-based (as opposed to nursing home-based) dialysis units only, as well as lack of hospitalization and mortality data. It is vital to understand the extent of spread (both symptomatic and asymptomatic) within a dialysis unit, with important ramifications from an infection prevention and control standpoint.…”