Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis. Issue 12 (30th December 2021)

• Record Type: Journal Article
• Authors: Bardossy, Ana Cecilia; Korhonen, Lauren; Schatzman, Sabrina; Gable, Paige; Herzig, Carolyn; Brown, Nicole E.; Beshearse, Elizabeth; Varela, Kate; Sabour, Sarah; Lyons, Amanda K.; Overton, Rahsaan; Hudson, Matthew; Hernandez-Romieu, Alfonso C.; Alvarez, Jorge; Roman, Kaylin; Weng, Mark; Soda, Elizabeth; Patel, Priti R.; Grate, Crystal; Dalrymple, Lorien S.; Wingard, Rebecca L.; Thornburg, Natalie J.; Halpin, Alison S. Laufer; Folster, Jennifer M.; Tobin-D'Angelo, Melissa; Lea, Janice; Apata, Ibironke; McDonald, L. Clifford; Brown, Allison C.; Kutty, Preeta K.; Novosad, Shannon;
• Other Names: Wilson W. Wyatt author non-byline.; Tobolowsky Farrell author non-byline.; Gilbert Sarah E. author non-byline.; Huang Jennifer author non-byline.; Gualandi Nicole author non-byline.; Ansari Uzma author non-byline.; Perry-Dow K. Allison author non-byline.; McAllister Gillian A. author non-byline.; Whitworth Carrie author non-byline.; Sanders Carrie author non-byline.; Tamin Azaibi author non-byline.; Harcourt Jennifer L. author non-byline.; Freeman Brandi author non-byline.; Lester Sandra author non-byline.; Mills Lisa author non-byline.; Stumpf Megan author non-byline.; Furin William author non-byline.; Spicer Lori author non-byline.; Adamczyk Michelle author non-byline.; Chan Monica author non-byline.; Bhatnagar Amelia author non-byline.; Reese Natashia author non-byline.; Balbuena Rocio author non-byline.; Anderson Karen author non-byline.; Lonsway David author non-byline.; Breaker Erin author non-byline.; Rasheed James K. author non-byline.; Houston Hollis author non-byline.; Crayton Karlos author non-byline.; Tran Lisa author non-byline.; Campbell Davina author non-byline.; Paulick Ashley Lyn author non-byline.; Gade Lalitha author non-byline.; Galloway Renee author non-byline.; Hartloge Claire author non-byline.; Jenkins Brent author non-byline.; Medrzycki Magdalena author non-byline.; Sahibzada Kashif author non-byline.; Shewmaker Patricia author non-byline.; Wynn Nhien author non-byline.; Velusamy Srinivasan author non-byline.; Wong Phili author non-byline.; Zheng HaoQiang author non-byline.; Tejada-Strop Alexandra author non-byline.; Jain Shilpi author non-byline.;
• Is Part Of: Kidney360. Volume 2:Issue 12(2021)
• Page Start: 1917
• Page End: 1927
• Publication Date: 2021-12-30
• Subjects: dialysis -- chronic kidney failure -- COVID-19 -- dialysis -- end-stage renal disease -- ESRD -- infectiousness -- infectivity -- outpatients -- SARS-CoV-2; 616.61
• DOI: 10.34067/KID.0004372021
• Languages: English
• ISSNs: 2641-7650

Abstract

Visual Abstract: Abstract : Key Points: Patients with ESKD on dialysis had persistent and intermittently positive RT-PCR tests for severe acute respiratory syndrome coronavirus 2. Evidence for presence of infectious virus was lacking in most cases. A symptom-based approach, instead of a test-based approach, should be used to decide when to discontinue transmission-based precautions. Background: Patients with ESKD on maintenance dialysis receive dialysis in common spaces with other patients and have a higher risk of severe SARS-CoV-2 infections. They may have persistently or intermittently positive SARS-CoV-2 RT-PCR tests after infection. We describe the clinical course of SARS-CoV-2 infection and the serologic response in a convenience sample of patients with ESKD to understand the duration of infectivity. Methods: From August to November 2020, we enrolled patients on maintenance dialysis with SARS-CoV-2 infections from outpatient dialysis facilities in Atlanta, Georgia. We followed participants for approximately 42 days. We assessed COVID-19 symptoms and collected specimens. Oropharyngeal (OP), anterior nasal (AN), and saliva (SA) specimens were tested for the presence of SARS-CoV-2 RNA, using RT-PCR, and sent for viral culture. Serology, including neutralizing antibodies, was measured in blood specimens. Results: Fifteen participants, with a median age of 58 (range, 37‒77) years, were enrolled. Median duration of RT-PCR positivity from diagnosis was 18 days (interquartile range [IQR], 8‒24 days). Ten participants had at least one, for a total of 41, positive RT-PCR specimens ≥10 days after symptoms onset. Of these 41 specimens, 21 underwent viral culture; one (5%) was positive 14 days after symptom onset. Thirteen participants developed SARS-CoV-2–specific antibodies, 11 of which included neutralizing antibodies. RT-PCRs remained positive after seroconversion in eight participants and after detection of neutralizing antibodies in four participants; however, all of these samples were culture negative. Conclusions: Patients with ESKD on maintenance dialysis remained persistently and intermittently SARS-CoV-2–RT-PCR positive. However, of the 15 participants, only one had infectious virus, on day 14 after symptom onset. Most participants mounted an antibody response, including neutralizing antibodies. Participants continued having RT-PCR–positive results in the presence of SARS-CoV-2–specific antibodies, but without replication-competent virus detected.