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Alcázar-Arroyo R, Portolés J, López-Sánchez P, Zalamea F, Furaz K, Méndez Á, Nieto L, Sánchez-Hernández R, Pizarro S, García A, Pereira M, Gallego-Valcárcel E, Llópez-Carratala R, Gadea-Gironés I, Martín R, Miranda B. Rapid decline of anti-SARS-CoV-2 antibodies in patients on haemodialysis: the COVID-FRIAT study. Clin Kidney J 2021; 14:1835-1844. [PMID: 34211708 PMCID: PMC7989535 DOI: 10.1093/ckj/sfab048] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) patients on haemodialysis (HD) have high mortality. We investigated the value of reverse transcription polymerase chain reaction (RT-PCR) and the dynamic changes of antibodies (enzyme-linked immunosorbent assay immunoglobulin M (IgM) + IgA and/or IgG) in a large HD cohort. METHODS We conducted a prospective observational study in 10 Madrid HD centres. Infection rate, anti-SARS-CoV-2 antibody dynamics and the incidence of asymptomatic SARS-CoV-2 infection (defined by positive RT-PCR, IgM + IgA and/or IgG) were assessed. RESULTS From 1 March to 15 April 2020, 136 of 808 (16.8%) HD patients were diagnosed with symptomatic COVID-19 by RT-PCR of nasopharyngeal swabs and 42/136 (31%) died. In the second fortnight of April, RT-PCR and anti-SARS-CoV-2 antibodies were assessed in 763 of the surviving patients. At this point, 69/91 (75.8%) symptomatic COVID-19 patients had anti-SARS-CoV-2 antibodies. Four weeks later, 15.4% (10/65) of initially antibody-positive patients had become negative. Among patients without prior symptomatic COVID-19, 9/672 (1.3%) were RT-PCR positive and 101/672 patients (15.0%) were antibody positive. Four weeks later, 62/86 (72.1%) of initially antibody-positive patients had become negative. Considering only IgG titres, serology remained positive after 4 weeks in 90% (54/60) of patients with symptomatic COVID-19 and in 52.5% (21/40) of asymptomatic patients. The probability of an adequate serologic response (defined as the development of anti-SARS-CoV-2 antibodies that persisted at 4 weeks) was higher in patients who had symptomatic COVID-19 than in asymptomatic SARS-CoV-2 infection {odds ratio [OR) 4.04 [95% confidence interval (CI) 2.04-7.99]} corrected for age, Charlson comorbidity index score and time on HD. Living in a nursing home [OR 5.9 (95% CI 2.3-15.1)] was the main risk factor for SARS-CoV-2 infection. CONCLUSIONS The anti-SARS-CoV-2 antibody immune response in HD patients depends on clinical presentation. The antibody titres decay earlier than previously reported for the general population. This inadequate immune response raises questions about the efficacy of future vaccines.
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Affiliation(s)
- Roberto Alcázar-Arroyo
- Department of Nephrology, University Hospital Infanta Leonor, Madrid, Spain
- Department of Medicine, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - José Portolés
- Department of Nephrology, University Hospital Puerta de Hierro, Madrid, Spain
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
| | - Paula López-Sánchez
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
| | - Felipe Zalamea
- Department of Nephrology, Dialysis Center–Los Lauros, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Karina Furaz
- Department of Nephrology, Dialysis Center–Los Llanos, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Ángel Méndez
- Department of Nephrology, Dialysis Center–Los Llanos II, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | - Luis Nieto
- Department of Nephrology, Dialysis Center–Santa Engracia, Fundación Renal Íñigo Álvarez de Toledo, Madrid, Spain
| | | | - Soledad Pizarro
- Department of Nephrology, University Hospital Rey Juan Carlos, Madrid, Spain
| | - Alicia García
- Department of Nephrology, University Hospital Infanta Elena, Madrid, Spain
| | - Mónica Pereira
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
- Department of Nephrology, Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo Gallego-Valcárcel
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
- Department of Nephrology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Rosario Llópez-Carratala
- Department of Nephrology, University Hospital Puerta de Hierro, Madrid, Spain
- Research Network REDInREN 016/009/009 Instituto Salud Carlos III, Madrid, Spain
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