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Abstract：
Patients receiving maintenance hemodialysis (MHD) are highly vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current study was designed to evaluate the prevalence of SARS-CoV-2 infection based on both nucleic acid testing (NAT) and antibody testing in Chinese patients receiving MHD.
Cross-sectional study.
From December 1, 2019, to March 31, 2020, a total of 1,027 MHD patients in 5 large hemodialysis centers in Wuhan, China, were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial computed tomography (CT) of the chest. If patients developed symptoms after the initial screening was negative, repeat CT was performed. Patients suspected of being infected with SARS-CoV-2 were tested with 2 consecutive throat swabs for viral RNA. In mid-March 2020, antibody testing for SARS-CoV-2 was obtained for all MHD patients.
NAT and antibody testing results for SARS-CoV-2.
Morbidity, clinical features, and laboratory and radiologic findings.
Differences between groups were examined using t test or Mann-Whitney U test, comparing those not infected with those infected and comparing those with infection detected using NAT with those with infection detected by positive serology test results.
Among 1,027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among the 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive immunoglobulin G (IgG) or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on CT of the chest compared with 11.6% among uninfected patients (P<0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and were more likely to be symptomatic than patients with another primary cause of kidney failure.
Possible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations.
Half the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal CT of the chest and selective NAT. Serologic testing may help evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.
Cross-sectional study.
From December 1, 2019, to March 31, 2020, a total of 1,027 MHD patients in 5 large hemodialysis centers in Wuhan, China, were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial computed tomography (CT) of the chest. If patients developed symptoms after the initial screening was negative, repeat CT was performed. Patients suspected of being infected with SARS-CoV-2 were tested with 2 consecutive throat swabs for viral RNA. In mid-March 2020, antibody testing for SARS-CoV-2 was obtained for all MHD patients.
NAT and antibody testing results for SARS-CoV-2.
Morbidity, clinical features, and laboratory and radiologic findings.
Differences between groups were examined using t test or Mann-Whitney U test, comparing those not infected with those infected and comparing those with infection detected using NAT with those with infection detected by positive serology test results.
Among 1,027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among the 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive immunoglobulin G (IgG) or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on CT of the chest compared with 11.6% among uninfected patients (P<0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and were more likely to be symptomatic than patients with another primary cause of kidney failure.
Possible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations.
Half the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal CT of the chest and selective NAT. Serologic testing may help evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.
摘要：
接受维持性血液透析（MHD）的患者极易感染严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）。本研究旨在根据接受MHD的中国患者的核酸检测（NAT）和抗体检测来评估SARS-CoV-2感染的患病率。
横断面研究。
自2019年12月1日至2020年3月31日，武汉市5家大型血液透析中心共1,027名MHD患者，中国,已注册。通过症状和胸部的初始计算机断层扫描（CT）对患者进行SARS-CoV-2感染筛查。如果患者在初次筛查后出现症状为阴性，进行重复CT检查.怀疑感染SARS-CoV-2的患者用2个连续的咽喉拭子检测病毒RNA。2020年3月中旬，对所有MHD患者进行了SARS-CoV-2抗体检测。
SARS-CoV-2的NAT和抗体检测结果。
发病率，临床特征,以及实验室和放射学发现。
使用t检验或Mann-WhitneyU检验检查组间差异，将未感染的患者与受感染的患者进行比较，并将使用NAT检测到的感染患者与血清学检测结果阳性的感染患者进行比较。
在接受MHD的1,027名患者中，99人被确定患有SARS-CoV-2感染，患病率为9.6%。在99个案例中，最初通过NAT阳性诊断为SARS-CoV-2感染52（53％）；后来通过针对SARS-CoV-2的免疫球蛋白G（IgG）或IgM抗体阳性鉴定了47（47％）。在这47例患者中有一系列的抗体谱：5例（11％）的IgM抗体，IgG抗体在35（74％），和IgM和IgG抗体在7（15％）。在99个案例中，51％的患者在流行期间无症状；61％的患者在胸部CT上有毛玻璃影或斑片状影，而未感染患者为11.6％（P<0.001）。高血压肾病患者更常被发现患有SARS-CoV-2感染，并且比其他主要原因导致肾衰竭的患者更有症状。
NAT和抗体检测可能的假阳性和假阴性结果；可能缺乏对其他透析人群的普适性。
接受MHD的患者中有一半的SARS-CoV-2感染是亚临床的，未通过胸部的通用CT和选择性NAT进行鉴定。血清学测试可能有助于评估感染SARS-CoV-2的MHD患者的总体患病率并了解临床病程的多样性。
横断面研究。
自2019年12月1日至2020年3月31日，武汉市5家大型血液透析中心共1,027名MHD患者，中国,已注册。通过症状和胸部的初始计算机断层扫描（CT）对患者进行SARS-CoV-2感染筛查。如果患者在初次筛查后出现症状为阴性，进行重复CT检查.怀疑感染SARS-CoV-2的患者用2个连续的咽喉拭子检测病毒RNA。2020年3月中旬，对所有MHD患者进行了SARS-CoV-2抗体检测。
SARS-CoV-2的NAT和抗体检测结果。
发病率，临床特征,以及实验室和放射学发现。
使用t检验或Mann-WhitneyU检验检查组间差异，将未感染的患者与受感染的患者进行比较，并将使用NAT检测到的感染患者与血清学检测结果阳性的感染患者进行比较。
在接受MHD的1,027名患者中，99人被确定患有SARS-CoV-2感染，患病率为9.6%。在99个案例中，最初通过NAT阳性诊断为SARS-CoV-2感染52（53％）；后来通过针对SARS-CoV-2的免疫球蛋白G（IgG）或IgM抗体阳性鉴定了47（47％）。在这47例患者中有一系列的抗体谱：5例（11％）的IgM抗体，IgG抗体在35（74％），和IgM和IgG抗体在7（15％）。在99个案例中，51％的患者在流行期间无症状；61％的患者在胸部CT上有毛玻璃影或斑片状影，而未感染患者为11.6％（P<0.001）。高血压肾病患者更常被发现患有SARS-CoV-2感染，并且比其他主要原因导致肾衰竭的患者更有症状。
NAT和抗体检测可能的假阳性和假阴性结果；可能缺乏对其他透析人群的普适性。
接受MHD的患者中有一半的SARS-CoV-2感染是亚临床的，未通过胸部的通用CT和选择性NAT进行鉴定。血清学测试可能有助于评估感染SARS-CoV-2的MHD患者的总体患病率并了解临床病程的多样性。
