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American Journal of Kidney Diseases

Is SARS-CoV-2 Serology Relevant for Hemodialysis Patients With COVID-19?

      To the Editor:
      Although dialysis patients are known to have impaired antibody responses to pathogens and fluctuation of antibody levels,
      • Meyer T.W.
      • Hostetter T.H.
      Uremia.
      the response to coronavirus disease 2019 (COVID-19) in this population remains to be determined. De Vriese and Reynders
      • De Vriese A.S.
      • Reynders M.
      IgG antibody response to SARS-CoV-2 infection and viral RNA persistence in patients on maintenance hemodialysis.
      present the first evaluation of potential antibody responses in a dialysis population. We agree that 2 sequential negative COVID-19 swabs before de-isolating dialysis patients is a reasonable approach, as we recently demonstrated.
      • Dudreuilh C.
      • Kumar N.
      • Moxham V.
      • Hemsley C.
      • Goldenberg S.
      • Moutzouris D.-A.
      De-isolation of COVID-19–positive hemodialysis patients in the outpatient setting: a single-center experience.
      De Vriese and Reynders studied the presence of immunoglobulin G (IgG) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid (N) protein in 7 patients and concluded that patients develop an antibody response within 15 days. Although we acknowledge that these findings are novel, we highlight that they might not be applicable to other dialysis populations with COVID-19 infection. First, the infection rate in their population was very low (7/289 [2.5%]) and most of these patients had a severe form of the disease (3 [43%] died and 1 was still in the intensive care unit [ICU]). In comparison, in our experience,
      • Roper T.
      • Kumar N.
      • Lewis-Morris T.
      • et al.
      Delivering dialysis during the COVID-19 outbreak: strategies and outcomes..
      11.3% of our hemodialysis population had COVID-19 infection and only 7 of 76 (9.2%) died. IgG against SARS-CoV-2 N protein has been shown to be higher in ICU compared with non-ICU patients.
      • Sun B.
      • Feng Y.
      • Mo X.
      • et al.
      Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients.
      Therefore, it remains to be elucidated whether those results are applicable to any hemodialysis population and whether there is a prognostic role in assessing anti-spike (S) protein IgG in combination with IgG against SARS-CoV-2 N protein.
      • Sun B.
      • Feng Y.
      • Mo X.
      • et al.
      Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients.
      Moreover, it remains to be confirmed how long these antibodies will last and their clinical relevance in larger populations.

      Article Information

      Financial Disclosure

      The authors declare that they have no relevant financial interests.

      Peer Review

      Received June 10, 2020. Accepted June 13, 2020, after editorial review by a Deputy Editor.

      References

        • Meyer T.W.
        • Hostetter T.H.
        Uremia.
        N Engl J Med. 2007; 57: 1316-1325
        • De Vriese A.S.
        • Reynders M.
        IgG antibody response to SARS-CoV-2 infection and viral RNA persistence in patients on maintenance hemodialysis.
        Am J Kidney Dis. 2020; 76: 440-441
        • Dudreuilh C.
        • Kumar N.
        • Moxham V.
        • Hemsley C.
        • Goldenberg S.
        • Moutzouris D.-A.
        De-isolation of COVID-19–positive hemodialysis patients in the outpatient setting: a single-center experience.
        Kidney Int. 2020; 98: 236-237
        • Roper T.
        • Kumar N.
        • Lewis-Morris T.
        • et al.
        Delivering dialysis during the COVID-19 outbreak: strategies and outcomes..
        Kidney Int Rep. 2020; 5: 1090-1094
        • Sun B.
        • Feng Y.
        • Mo X.
        • et al.
        Kinetics of SARS-CoV-2 specific IgM and IgG responses in COVID-19 patients.
        Emerg Microbes Infect. 2020; 9: 940-948

      Linked Article

      • IgG Antibody Response to SARS-CoV-2 Infection and Viral RNA Persistence in Patients on Maintenance Hemodialysis
        American Journal of Kidney DiseasesVol. 76Issue 3
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          Quarantining dialysis patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a logistical challenge. Appropriately identifying noninfectiousness in patients is essential to safely lift quarantine measures. Serologic tests are used to establish previous infection with SARS-CoV-2, but the extent to which antibody positivity translates to actual immunity is currently unknown.1 Hemodialysis patients are known to have impaired humoral immune responses to vaccination and infection, and it is uncertain whether hemodialysis patients mount an effective antibody response against SARS-CoV-2.
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      • In Reply to ‘Is SARS-CoV-2 Serology Relevant for Hemodialysis Patients With COVID-19?’
        American Journal of Kidney DiseasesVol. 76Issue 4
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          In a small group of hemodialysis patients with confirmed SARS-CoV-2 infection, we reported that the presence of anti–SARS-CoV-2 IgG overlaps by several weeks with detectable viral RNA in the upper airways.1 The core message of our communication is that this antibody response, although proof of recent exposure to SARS-CoV-2, should not be interpreted as prima facie evidence of immunity to the virus. Viral load was highest during the first week of illness, suggesting that patients are most infectious during this period.
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