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Prevalence of SARS-CoV-2 Antibodies in Dialysis Patients
Quick Takes
- This analysis from a nationwide sample of dialysis patients reports that despite the United States leading in the number of diagnosed cases, overall, <10% of US adults had evidence of seroconversion in July 2020.
- Public health efforts to curb the spread of the virus need to continue, with focus on some of the highest-risk communities identified, such as majority Black and Hispanic neighborhoods, poorer neighborhoods, and densely populated metropolitan areas.
- A surveillance strategy relying on monthly testing of patients receiving dialysis can inform disease trends, resource allocation, and effectiveness of community interventions during the COVID-19 pandemic.
Study Questions:
What is the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in a large nationwide sample of patients on dialysis in the United States?
Methods:
The investigators, in partnership with a central laboratory that receives samples from approximately 1,300 dialysis facilities across the United States, tested the remainder plasma of 28,503 randomly selected adult patients receiving dialysis in July 2020, using a spike protein receptor binding domain total antibody chemiluminescence assay (100% sensitivity, 99.8% specificity). They extracted data on age, sex, race and ethnicity, and residence and facility zip codes from the anonymized electronic health records, linking patient-level residence data with cumulative and daily cases and deaths per 100,000 population and with nasal swab test positivity rates. The authors standardized prevalence estimates according to the overall US dialysis and adult population, and present estimates for four prespecified strata (age, sex, region, and race and ethnicity).
Results:
The sampled population had similar age, sex, and race and ethnicity distribution to the US dialysis population, with a higher proportion of older people, men, and people living in majority Black and Hispanic neighborhoods than in the US adult population. Seroprevalence of SARS-CoV-2 was 8.0% (95% confidence interval [CI], 7.7–8.4) in the sample, 8.3% (8.0–8.6) when standardized to the US dialysis population, and 9.3% (8.8–9.9) when standardized to the US adult population. When standardized to the US dialysis population, seroprevalence ranged from 3.5% (3.1–3.9) in the west to 27.2% (25.9–28.5) in the northeast. Comparing seroprevalent and case counts per 100,000 population, they found that 9.2% (8.7–9.8) of seropositive patients were diagnosed. When compared with other measures of SARS-CoV-2 spread, seroprevalence correlated best with deaths per 100,000 population (Spearman's ρ = 0.77). Residents of non-Hispanic Black and Hispanic neighborhoods experienced higher odds of seropositivity (odds ratio, 3.9 [95% CI 3.4–4.6] and 2.3 [1.9–2.6], respectively) compared with residents of predominantly non-Hispanic white neighborhoods. Residents of neighborhoods in the highest population density quintile experienced increased odds of seropositivity (10.3 [8.7–12.2]) compared with residents of the lowest density quintile. County mobility restrictions that reduced workplace visits by ≥5% in early March 2020 were associated with lower odds of seropositivity in July 2020 (0.4 [0.3–0.5]) when compared with a reduction of <5%.
Conclusions:
The authors concluded that during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, <10% of the US adult population formed antibodies against SARS-CoV-2, and <10% of those with antibodies were diagnosed.
Perspective:
This analysis of seroprevalence of SARS-CoV-2 antibodies from a nationwide sample of dialysis patients reports that despite the United States leading in the number of diagnosed cases, overall, <10% of US adults had evidence of seroconversion in July 2020. Furthermore, a vast majority of US adults, including people on dialysis who are among the highest risk for mortality upon contracting SARS-CoV-2, do not have evidence of exposure or immune response. Public health efforts to curb the spread of the virus need to continue, with focus on some of the highest-risk communities identified, such as majority Black and Hispanic neighborhoods, poorer neighborhoods, and densely populated metropolitan areas. A surveillance strategy relying on monthly testing of patients on dialysis can apprise on disease trends, resource allocation, and effectiveness of interventions during the COVID-19 pandemic.
Clinical Topics: COVID-19 Hub, Diabetes and Cardiometabolic Disease, Prevention
Keywords: Coronavirus, COVID-19, Dialysis, Electronic Health Records, Ethnic Groups, Metabolic Syndrome, Primary Prevention, Public Health, Seroepidemiologic Studies, Spike Glycoprotein, Coronavirus
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