Thread by @aishaikh

⚡️Excited to share our work:

“Prolonged SARS-CoV-2 Viral RNA Shedding and IgG Antibody Response to SARS-CoV-2 in Patients on Hemodialysis” published in @CJASN Summary👇🏽

👉🏽 cjasn.asnjournals.org/content/clinja…

@aishaikh @ZeldisEtti @kirkcampbell @LilCh4n
1/

https://twitter.com/cjasn/status/1316423653576368129

⚡️Background

❓Are patients on maintenance hemodialysis able to develop IgG antibodies to the SARS-CoV-2 virus after COVID-19 infection?

❓What is the duration of SARS-CoV-2 viral RNA shedding among HD patients following the diagnosis of COVID-19?

2/

💥Case Series of patients on maintenance hemodialysis (HD) at a single HD unit in NYC

⚡️Patients were tested for SARS-CoV-2 RNA (RT-PCR) if they had signs or symptoms suggestive of COVID-19, or the testing was performed as part of routine surveillance

3/

💥Diagnosis of COVID-19 was made if the patient tested positive for SARS-CoV-2 RNA (on nasal or nasopharyngeal swab)

⚡️Following the diagnosis of COVID-19, SARS-CoV-2 RNA test was performed at varying intervals to document clearance of the viral RNA

4/

💥SARS-CoV-2 IgG antibody testing was performed on all hemodialysis patients with the confirmed diagnosis of COVID-19

⚡️SARS-CoV-2 IgG antibody testing was performed using the Abbot IgG antibody test (cutoff index >1.4)

5/

💥Results:

⚡️26% (22/85) developed COVID-19
⚡️21 patients presented with signs & symptoms of COVID-19
⚡️One patient was asymptomatic and diagnosed on surveillance testing

⚡️Characteristics of HD patients with & without COVID-19 are shown below👇🏽

6/

💥86% (19/22) of the patients with COVID-19 patients had follow-up SARS-CoV-RNA testing after a median of 14 days (range, 9-39) following the initial positive SARS-CoV-2 RNA swab test that led to the diagnosis of COVID-19

7/

💥68% (13/19) of the hemodialysis patients with COVID-19 continued to test positive for SARS-CoV-2 RNA after 20 days and 32% (6/19) after 40 days.

⚡️See Figure 1B👇🏽

8/

💥19 patients with COVID-19 had follow-up SARS-CoV-2 RNA swab testing:

⚡️2 patients continued to test positive for SARS-CoV-2 RNA until they died

⚡️17 patients had 2 consecutive negative SAR-CoV-2 RNA swabs after a median of 30 days (range, 12-56)

9/

💥5 COVID-19 patients tested + again for SARS-CoV-2 RNA on follow-up test despite having 2 prior consecutive neg. swabs.
This occurred 52 days (median, range, 38-74) following diagnosis of COVID-19
⚡️4 patients were asymptomatic & 1 on chronic vent.

10/

💥IgG antibody testing was performed in 19 of the 22 COVID-19 patients after a median of 35 days (range, 17-48) following the diagnosis of COVID-19

⚡️All patients tested positive for IgG antibodies with a median Ab titer of 7.2 (IQR, 6.6-7.8)

11/

💥Serial IgG antibody testing was performed at 2- and 4-week intervals following the initial antibody test in 18 out of the 19 surviving patients

⚡️Median Ab titers were 7.6 (IQR, 7.1-7.9) & 8.9 (IQR, 8.2-9.9) respectively - see Figure 1C👇🏽

12/

💥SARS-CoV-2 IgG antibodies were present in all the COVID-19 patients after a median of 63 days following the COVID-19 diagnosis

⚡️There was no difference between the antibody titers in patients who required hospitalization & those who did not

13/

💥In 37% (7/19) patients, SARS-CoV-2 RNA was detectable on the swab test despite the presence of IgG antibodies

14/

💥Summary:

⚡️Significance of prolonged SARS-CoV-2 viral RNA shedding in COVID-19 HD pts. who have clinically recovered & have developed IgG antibodies remains unclear

⚡️Defining when the shed viral particles are no longer infectious is a crucial need

15/

💥Summary:

⚡️In this series, development of SARS-CoV-2 IgG antibodies by all the HD patients in response to COVID-19 is encouraging, but whether this confers long lasting immunity remains to be seen

👉🏽 cjasn.asnjournals.org/content/clinja…

@CJASN

End/