The Cumulative Rate of SARS-CoV-2 Infection in Chinese Hemodialysis Patients

Xin Xu; Sheng Nie; Jian Sun; Yaozhong Kong; Min Liang; Dongfeng Li; Tean Ma; Jiaqing Peng; Shikui Gao; Yong Shao; Yan Zha; Gangyi Peng; Chanjun Ren; Ailong Huang; Fan Fan Hou

doi:10.1016/j.ekir.2020.07.010

The Cumulative Rate of SARS-CoV-2 Infection in Chinese Hemodialysis Patients

Kidney Int Rep. 2020 Sep;5(9):1416-1421. doi: 10.1016/j.ekir.2020.07.010. Epub 2020 Jul 18.

Authors

Xin Xu^{1

2}, Sheng Nie^{1

2}, Jian Sun^{1

2}, Yaozhong Kong³, Min Liang^{1

2}, Dongfeng Li⁴, Tean Ma⁵, Jiaqing Peng⁶, Shikui Gao⁷, Yong Shao⁸, Yan Zha⁹, Gangyi Peng¹⁰, Chanjun Ren¹¹, Ailong Huang¹², Fan Fan Hou^{1

2

13}

Affiliations

¹ State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Guangzhou, China.
² Nanfang Hospital, Southern Medical University, Guangzhou, China.
³ Department of Nephrology, The First People's Hospital of Foshan, Foshan, China.
⁴ The People`s Hospital of Honghu, Honghu, China.
⁵ Department of Nephrology, The First People's Hospital of Jingzhou, Jingzhou, China.
⁶ Department of Nephrology, Jingzhou Central Hospital, Jingzhou, China.
⁷ Department of Nephrology, Honghu Traditional Chinese Medicine Hospital, Honghu, China.
⁸ Department of Nephrology, The Second People's Hospital of Honghu, Honghu, China.
⁹ Department of Nephrology, Guizhou Provincial People's Hospital, Guizhou University, Guiyang, China.
¹⁰ Bureau of Medical Administration, Health Commission of Guangdong, Guangdong, China.
¹¹ Wuhan Kingmed Medical Laboratory, Wuhan, China.
¹² Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China.
¹³ Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.

Abstract

Background: There is a paucity of information regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients undergoing maintenance hemodialysis. We aimed to estimate the cumulative attack rate of SARS-CoV-2 in hemodialysis patients in China using a serological test.

Methods: We enrolled all hemodialysis patients from 8 hemodialysis facilities in Honghu and Jingzhou of Hubei province and Guangzhou and Foshan of Guangdong province in China. We screened these patients for SARS-CoV-2 infection by both a reverse-transcriptase polymerase chain reaction (RT-PCR) test for viral RNA and a serological test for IgG and IgM antibodies. Data on demographics and clinical characteristics were collected via case report forms. We also enrolled the health care workers from the participating hospitals and compared the seropositive rate between hemodialysis patients and health care workers in the same region.

Results: Among 1542 hemodialysis patients, 5 (0.32%) and 51 (3.3%) were tested positive by the RT-PCR test and the serological test, respectively. The seropositive rate in Hubei (3.6%) was higher than that in Guangdong (2.8%), although the difference was not statistically significant (P = 0.5). Most of the seropositive patients were asymptomatic. Independent risk factors for SARS-CoV-2 infection were being older than 65 years, having manifestation of lung infection in imaging examinations, and having a lower level of serum albumin. In comparison, the seropositive rate in 3205 health care workers was 1.2%，which was significantly lower than that observed in the hemodialysis patients (P < .001).

Conclusion: The cumulative rate of SARS-CoV-2 infection in hemodialysis patients in China was high at 3.3%. Serological test detected 10 times more cases of SARS-CoV-2 infection than the RT-PCR test and should be the preferred tool for estimating the prevalence of coronavirus disease 2019 (COVID-19).

Keywords: COVID-19; antibody; hemodialysis.