Weekly Rapid Antigen Test Screening for COVID-19 in Patients on Hemodialysis

Abstract

Background/Aim: COVID-19 is a concerning issue among in-center hemodialysis (HD) patients. To prevent COVID-19 diffusion in our HD facility, weekly rapid nasal antigen test screening was performed for all asymptomatic patients on chronic HD. This study aimed to assess the performance of weekly rapid antigen test in detecting SARS-CoV-2 infection among asymptomatic patients receiving HD. Patients and Methods: A retrospective analysis was conducted in HD patients who underwent rapid antigen test screening from December 2021 to March 2022. The diagnosis of COVID-19 with rapid antigen test was always confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR). Results: During the observational period, 1,748 rapid antigen tests were performed in 220 HD patients. Mean age was 68.4±14.6 years. Fifteen (8.5%) patients resulted positive for SARS-CoV-2 infection using rapid antigen tests. The diagnosis was subsequently confirmed in 14 (93.3%) patients by RT-PCR. During the same period, 12 (5.4%) symptomatic patients, regularly screened with weekly rapid antigen test, resulted positive for SARS-CoV-2 infection using RT-PCR. Overall, weekly rapid antigen test screening identified 14 out of 26 (53.8%) COVID-19 cases and showed a positive predictive value of 93%. Conclusion: Weekly antigen test screening of asymptomatic patients on chronic HD detected around half of the COVID-19 cases in our population.Patients on maintenance hemodialysis (HD) are a subset of the population extremely susceptible to the severe consequences of COVID-19. Advanced age, high prevalence of diabetes and cardiovascular disease, as well as immunosuppression due to end-stage kidney disease, are the main determinants of poor outcomes in this population (1-5). Patients on in-center HD also carry a significant risk of contracting SARS-CoV-2 infection, as they may share with potentially infected subjects enclosed spaces including the dialysis room, dressing room, and transportation (6). Based on this background, a sensitive testing screening for the early diagnosis of COVID-19 might be an ideal solution to prevent deadly outbreaks within the dialysis units (7). Unfortunately, no guidelines have been released on the utility of screening for the high-risk HD population until now. COVID-19 screening program is often facultative and modalities vary enormously among HD centers worldwide. Universal screening may be useful in settings with high community prevalence (8). Two types of diagnostic tests are currently used for assessing COVID-19: detection of viral RNA 2823

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

“…A similar study conducted from December 2021 to March 2022 used RAT to screen 220 haemodialysis patients, and 8.5% of asymptomatic patients returned a positive test over this time period (93% were subsequently confirmed COVID-19 positive by PCR testing). Symptomatic patients were screened with a PCR test, and of those who tested positive on PCR, RAT picked up 54% of cases as being COVID-19 positive [ 74 ].…”