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

INTRODUCTION: 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 by means of case report forms. We also enrolled the health care workers (HCWs) from the participating hospitals and compared the seropositive rate between hemodialysis patients and HCWs in the same region. RESULTS: Among 1542 hemodialysis patients, 5 (0.32%) and 51 (3.3%) 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 age greater than 65 years, a manifestation of lung infection on imaging examinations, and 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%. The 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).