Patients on hemodialysis (HD) who have naturally acquired immunity to SARS-CoV-2 due to previous infection are more prone to reinfection than their counterparts in the general population, investigators suggest.

In a study of 2337 unvaccinated adults receiving in-center HD, 9.5% had SARS-CoV-2 immunoglobulin G (IgG) antibodies at baseline and 3.6% had a clinical history of COVID-19. After an infection-free period (based on negative PCR tests), investigators assessed the risk for reinfection.

Over 6679 patient-months of follow-up, 263 patients had evidence of SARS-CoV-2 infection, including 141 who had clinically manifest COVID-19. The rate of new infections was higher among previously uninfected patients: 4.1 vs 2.3 per 100 person-months for those with and without history of COVID-19 based on IgG test results and and 4.0 vs 2.1 per 100 person-months, respectively, based on clinical history.

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Anti-SARS-CoV-2 IgG seropositivity was associated with a significant 45% lower risk of subsequent SARS-CoV-2 infection and a significant 79% lower risk of clinically manifest COVID-19 in patients on HD, Steven M. Brunelli, MD, of DaVita Clinical Research in Minneapolis, Minnesota, and colleagues reported in the Journal of the American Society of Nephrology.

According to the team, “these data demonstrate that protection afforded by natural immunity to SARS-CoV-2 among patients treated with [in-center] HD is present but incomplete, and is of lower magnitude than in younger, relatively healthy populations.

“These findings support two current recommendations: first, that older individuals and those with chronic disease should be prioritized for COVID-19 vaccination; and second, that decisions on vaccine candidacy should be made independent of prior disease history or serologic status.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Cohen DE, Sibbel S, Marlowe G, et al. Antibody status, disease history, and incidence of SARS-CoV-2 infection among patients on chronic dialysis. J Am Soc Nephrol. Published online July 2, 2021. doi:10.1681/ASN.2021030387