Background Dialysis confers the highest risk of COVID-19 death among comorbidities predisposing to severe COVID-19. However, reports of COVID-19-associated mortality frequently refer to mortality during the initial hospitalization or first month after diagnosis. Methods In a prospective, observational study, we have analyzed the long-term (one year follow-up) serological and clinical outcomes of 56 hemodialysis patients that were infected by SARS-CoV-2 during the first pandemic wave. COVID-19 was diagnosed by a positive PCR test (n = 37) or by the development of anti-SARS-CoV-2 antibodies (n = 19). Results After over one year of follow-up, 35.7% of hemodialysis patients infected by SARS-COV-2 during the first pandemic wave had died, 6 (11%) during the initial admission, and 14 (25%) died in the following months, mainly within the first 3 months after diagnosis. Overall, 30% of patients died from vascular causes, and 40% from respiratory causes. In adjusted analysis, positive SARS-CoV-2 PCR test for diagnosis (HR 5.18 [1.30–20.65] p = 0.020), higher baseline C reactive protein levels (HR 1.10 [1.03–1.16] p = 0.002) and lower hemoglobin levels (HR 0.62 [0.45–0.86] p = 0.005) were associated with higher one-year mortality. Mortality in the 144 patients that did not have COVID-19 was 21 (14.6%) over 12 months [hazard ratio for death for COVID-19 patients 3.00 (1.62–5.53), log-rank p = 0.00023]. Over the first year, the percentage of patients having anti-SARS-CoV-2 IgG decreased from 36/49 (73.4%) initially to 27/44 (61.3%) at 6 months, and 14/36 (38.8%) at 12 months. Conclusions The high mortality of hemodialysis patients with COVID-19 is not limited to the initial hospitalization. Defining COVID-19 deaths as those occurring within 3 months of a COVID-19 diagnosis may better represent the burden of COVID-19. In hemodialysis patients, the anti-SARS-CoV-2 IgG response was suboptimal and short-lived.

Introduction: The inherent immunosuppression of uremia increases the susceptibility of hemodialysis patients to infection. There is still limited evidence on hemodialysis patients and COVID-19. The clinical and analytical spectrum and treatment responses and mortality are poorly characterized. Material and Methods: Clinical and analytical features, chest X-ray, polymerase chain reaction (PCR) and antibodies for SARS-CoV-2, treatment and outcomes were analyzed in 48 patients diagnosed with COVID-19 during March and April 2020 in two coordinated Spanish hemodialysis units. Results: In 200 haemodialysis patients, COVID-19 was diagnosed in 48, of whom 22 were PCR positive, eight PCR negative but seroconverted and two were diagnosed on typical clinical grounds. Despite a mean age of 72.6 years, the overall mortality rate was 5/48 (10%). Among the PCR positive patients, 21 (55%) required admission and five (13%) died. PCR positive patients were more often symptomatic and hospitalized and had higher troponin I levels than PCR negative patients, but did not differ in lymphocyte counts, D-dimer or interleukin-6 (IL-6) levels. Among PCR negative COVID-19 patients, three out of 10 (30%) required admission, and none died. The most frequent symptom among the 48 patients was fever (31%), followed by asymptomatic patients (23%). A low number of lymphocytes was the only parameter significantly different between hospitalized and ambulatory COVID-19 patients, independently of PCR status. Conclusions: COVID-19 hemodialysis patients are frequently asymptomatic, and mortality may be lower than previously reported. Diagnosis may be retrospective, based on seroconversion, as PCR may be negative. This information should guide preventive and patient isolation strategies.

<b><i>Background:</i></b> CKD is a risk factor for severe COVID-19. However, the clinical spectrum of COVID-19 in hemodialysis patients is still poorly characterized. <b><i>Objective:</i></b> To analyze the clinical spectrum of COVID-19 on hemodialysis patients. <b><i>Method:</i></b> A retrospective observational study was conducted on 66 hemodialysis patients. Nasopharyngeal swab PCR and serology for SARS-CoV-2, blood analysis, chest radiography, treatment, and outcomes were assessed. <b><i>Results:</i></b> COVID-19 was diagnosed in 50 patients: 38 (76%) were PCR-positive and 12 (24%) were PCR-negative but developed anti-SARS-CoV-2 antibodies. By contrast, 17% of PCR-positive patients failed to develop detectable antibodies against SARS-CoV-2. Among PCR-positive patients, 5/38 (13%) were asymptomatic, while among PCR-negative patients 7/12 (58%) were asymptomatic (<i>p</i> = 0.005) for a total of 12/50 (24%) asymptomatic patients. No other differences were found between PCR-positive and PCR-negative patients. No differences in potential predisposing factors were found between asymptomatic and symptomatic patients except for a lower use of ACE inhibitors among asymptomatic patients. Asymptomatic patients had laboratory evidence of milder disease such as higher lymphocyte counts and oxygen saturation and lower troponin I and interleukin-6 levels than symptomatic patients. Overall mortality was 7/50 (14%) and occurred only in symptomatic PCR-positive patients in whom mortality was 7/33 (21%). <b><i>Conclusions:</i></b> Asymptomatic SARS-CoV-2 infection is common in hemodialysis patients, especially among patients with initial negative PCR that later seroconvert. Thus COVID-19 mortality in hemodialysis patients may be lower than previously estimated based on PCR tests alone.