• Candice L Clarke, Maria Prendecki, Amrita Dhutia, Jaslyn Gan, Claire Edwards, Virginia Prout, Liz Lightstone, Eleanor Parker, Federica Marchesin, Megan Griffith, Rawya Charif, Graham Pickard, Alison Cox, Myra McClure, Richard Tedder, Paul Randell, Louise Greathead, Mary Guckian, Stephen P McAdoo, Peter Kelleher, and Michelle Willicombe.
• Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK; Imperial College Renal and Transplant Centre, Division of Medicine, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK. Electronic address: candice.clarke@imperial.ac.uk.
• Kidney Int. 2021 Jun 1; 99 (6): 1470-1477.

AbstractPatients with end stage kidney disease receiving in-center hemodialysis (ICHD) have had high rates of SARS-CoV-2 infection. Following infection, patients receiving ICHD frequently develop circulating antibodies to SARS-CoV-2, even with asymptomatic infection. Here, we investigated the durability and functionality of the immune responses to SARS-CoV-2 infection in patients receiving ICHD. Three hundred and fifty-six such patients were longitudinally screened for SARS-CoV-2 antibodies and underwent routine PCR-testing for symptomatic and asymptomatic infection. Patients were regularly screened for nucleocapsid protein (anti-NP) and receptor binding domain (anti-RBD) antibodies, and those who became seronegative at six months were screened for SARS-CoV-2 specific T-cell responses. One hundred and twenty-nine (36.2%) patients had detectable antibody to anti-NP at time zero, of whom 127 also had detectable anti-RBD. Significantly, at six months, 71/111 (64.0%) and 99/116 (85.3%) remained anti-NP and anti-RBD seropositive, respectively. For patients who retained antibody, both anti-NP and anti-RBD levels were reduced significantly after six months. Eleven patients who were anti-NP seropositive at time zero, had no detectable antibody at six months; of whom eight were found to have SARS-CoV-2 antigen specific T cell responses. Independent of antibody status at six months, patients with baseline positive SARS-CoV-2 serology were significantly less likely to have PCR confirmed infection over the following six months. Thus, patients receiving ICHD mount durable immune responses six months post SARS-CoV-2 infection, with fewer than 3% of patients showing no evidence of humoral or cellular immunity.Copyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

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