Longevity of SARS-CoV-2 immune responses in hemodialysis patients and protection against reinfection

Kidney Int. 2021 Jun;99(6):1470-1477. doi: 10.1016/j.kint.2021.03.009. Epub 2021 Mar 25.


Patients 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.

Keywords: COVID-19; SARS-CoV-2; hemodialysis; serology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Viral / analysis*
  • COVID-19 / immunology*
  • COVID-19 Testing
  • Female
  • Humans
  • Immunity
  • Kidney Failure, Chronic / therapy*
  • Male
  • Pandemics
  • Polymerase Chain Reaction
  • Reinfection
  • Renal Dialysis / adverse effects*
  • SARS-CoV-2 / immunology*
  • SARS-CoV-2 / isolation & purification
  • Serologic Tests / methods


  • Antibodies, Viral