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Prevalence of SARS-CoV-2 antibodies in a large nationwide sample of patients on dialysis in the USA: a cross-sectional study.
Anand, Shuchi; Montez-Rath, Maria; Han, Jialin; Bozeman, Julie; Kerschmann, Russell; Beyer, Paul; Parsonnet, Julie; Chertow, Glenn M.
  • Anand S; Division of Nephrology, Stanford University, Palo Alto, CA, USA. Electronic address: sanand2@stanford.edu.
  • Montez-Rath M; Division of Nephrology, Stanford University, Palo Alto, CA, USA.
  • Han J; Division of Nephrology, Stanford University, Palo Alto, CA, USA.
  • Bozeman J; Ascend Clinical Laboratory, Redwood City, CA, USA.
  • Kerschmann R; Ascend Clinical Laboratory, Redwood City, CA, USA.
  • Beyer P; Ascend Clinical Laboratory, Redwood City, CA, USA.
  • Parsonnet J; Division of Infectious Diseases & Geographic Medicine, Stanford University, Palo Alto, CA, USA; Department of Medicine, and Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA.
  • Chertow GM; Division of Nephrology, Stanford University, Palo Alto, CA, USA; Department of Medicine, and Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA.
Lancet ; 396(10259): 1335-1344, 2020 10 24.
Article in English | MEDLINE | ID: covidwho-1337016
Semantic information from SemMedBD (by NLM)
1. Antibodies PART_OF 2019 novel coronavirus
Subject
Antibodies
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PART_OF
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2019 novel coronavirus
2. Dialysis procedure ADMINISTERED_TO Patients
Subject
Dialysis procedure
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Patients
3. Chemiluminescence assay USES Total immunoglobulin measurement
Subject
Chemiluminescence assay
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USES
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Total immunoglobulin measurement
4. Plasma PART_OF Patients
Subject
Plasma
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PART_OF
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Patients
5. Partnership LOCATION_OF Cross-Sectional Studies
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Cross-Sectional Studies
6. GJA1 gene|GJA1 ASSOCIATED_WITH Hydranencephaly with Renal Aplasia-Dysplasia
Subject
GJA1 gene|GJA1
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ASSOCIATED_WITH
Object
Hydranencephaly with Renal Aplasia-Dysplasia
7. Antibodies PART_OF 2019 novel coronavirus
Subject
Antibodies
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PART_OF
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2019 novel coronavirus
8. Dialysis procedure ADMINISTERED_TO Patients
Subject
Dialysis procedure
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ADMINISTERED_TO
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Patients
9. Chemiluminescence assay USES Total immunoglobulin measurement
Subject
Chemiluminescence assay
Predicate
USES
Object
Total immunoglobulin measurement
10. Plasma PART_OF Patients
Subject
Plasma
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PART_OF
Object
Patients
11. Partnership LOCATION_OF Cross-Sectional Studies
Subject
Partnership
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LOCATION_OF
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Cross-Sectional Studies
12. GJA1 gene|GJA1 ASSOCIATED_WITH Hydranencephaly with Renal Aplasia-Dysplasia
Subject
GJA1 gene|GJA1
Predicate
ASSOCIATED_WITH
Object
Hydranencephaly with Renal Aplasia-Dysplasia
ABSTRACT

BACKGROUND:

Many patients receiving dialysis in the USA share the socioeconomic characteristics of underserved communities, and undergo routine monthly laboratory testing, facilitating a practical, unbiased, and repeatable assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence.

METHODS:

For this cross-sectional study, in partnership with a central laboratory that receives samples from approximately 1300 dialysis facilities across the USA, we 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). We extracted data on age, sex, race and ethnicity, and residence and facility ZIP codes from the anonymised 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. We standardised 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).

FINDINGS:

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 neighbourhoods than in the US adult population. Seroprevalence of SARS-CoV-2 was 8·0% (95% CI 7·7-8·4) in the sample, 8·3% (8·0-8·6) when standardised to the US dialysis population, and 9·3% (8·8-9·9) when standardised to the US adult population. When standardised 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, we 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 neighbourhoods 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 neighbourhoods. Residents of neighbourhoods 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 at least 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 less than 5%.

INTERPRETATION:

During the first wave of the COVID-19 pandemic, fewer than 10% of the US adult population formed antibodies against SARS-CoV-2, and fewer than 10% of those with antibodies were diagnosed. Public health efforts to limit SARS-CoV-2 spread need to especially target racial and ethnic minority and densely populated communities.

FUNDING:

Ascend Clinical Laboratories.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Renal Dialysis / SARS-CoV-2 / COVID-19 / Antibodies, Viral Subject: Renal Dialysis / SARS-CoV-2 / COVID-19 / Antibodies, Viral Type of study: Prevalence study / Risk factors Language: English Journal: Lancet Clinical aspect: Diagnosis Year: 2020

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Renal Dialysis / SARS-CoV-2 / COVID-19 / Antibodies, Viral Subject: Renal Dialysis / SARS-CoV-2 / COVID-19 / Antibodies, Viral Type of study: Prevalence study / Risk factors Language: English Journal: Lancet Clinical aspect: Diagnosis Year: 2020
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