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

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

BACKGROUND: There is a paucity of information regarding 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. METHOD: We enrolled all hemodialysis patients from 8 hemodialysis facilities in Honghu and Jingzhou of Huibei province and Guangzhou and Foshan of Guangdong province in China. We screened these patients for SARS-CoV-2 infection by both a 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 healthcare workers (HCWs) from the participating hospitals and compared the seropositive rate between hemodialysis patients and HCWs in the same region. RESULT: Among 1,542 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%), though the difference was not statistically significant (p=0.5). Most of the seropositive patients were asymptomatic. Older than 65 years, having manifestation of lung infection in imaging examines, and lower level of serum albumin were independent risk factors for SARS-CoV-2 infection. In comparison, the seropositive rate in 3,205 HCWs was 1.2% which was significantly lower than that observed in the hemodialysis patients (p<0.001). 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 COVID-19.