• Hui Tang, Jian-Bo Tian, Jun-Wu Dong, Xiao-Tie Tang, Zhen-Yuan Yan, Yuan-Yuan Zhao, Fei Xiong, Xin Sun, Cai-Xia Song, Chang-Gang Xiang, Can Tu, Chun-Tao Lei, Jing Liu, Hua Su, Jing Huang, Yang Qiu, Xiao-Ping Miao, and Chun Zhang.
• Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• Am. J. Kidney Dis. 2020 Oct 1; 76 (4): 490-499.e1.

Rationale & ObjectivePatients 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.Study DesignCross-sectional study.Setting & ParticipantsFrom December 1, 2019, to March 31, 2020, a total of 1,027 MHD patients in 5 large hemodialysis centers in Wuhan, China, were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial computed tomography (CT) of the chest. If patients developed symptoms after the initial screening was negative, repeat CT was performed. Patients suspected of being infected with SARS-CoV-2 were tested with 2 consecutive throat swabs for viral RNA. In mid-March 2020, antibody testing for SARS-CoV-2 was obtained for all MHD patients.ExposureNAT and antibody testing results for SARS-CoV-2.OutcomesMorbidity, clinical features, and laboratory and radiologic findings.Analytical ApproachDifferences between groups were examined using t test or Mann-Whitney U test, comparing those not infected with those infected and comparing those with infection detected using NAT with those with infection detected by positive serology test results.ResultsAmong 1,027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among the 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive immunoglobulin G (IgG) or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on CT of the chest compared with 11.6% among uninfected patients (P<0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and were more likely to be symptomatic than patients with another primary cause of kidney failure.LimitationsPossible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations.ConclusionsHalf the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal CT of the chest and selective NAT. Serologic testing may help evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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