Kinetics of Anti-SARS-CoV-2 IgG Antibodies in Hemodialysis Patients Six Months after Infection

Abstract

Background: The humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the hemodialysis population, including its dynamics over time, remains poorly understood.

Methods: To analyze initial and long-term humoral responses against SARS-CoV-2 in a hemodialysis population, we retrospectively evaluated findings from SARS-CoV-2 IgG serologic assays targeting the nucleocapsid antigen or spike antigen up to 6 months of follow-up in patients on hemodialysis in the Paris, France, region who had recovered from coronavirus disease 2019 (COVID-19).

Results: Our analysis included 83 patients (median age 65 years); 59 (71%) were male and 28 (34%) had presented with severe COVID-19. We observed positive initial SARS-CoV-2 IgG antinucleocapsid serology in 74 patients (89%) at a median of 67 days postdiagnosis. By multivariable analysis, immunocompromised status was the only factor significantly associated with lack of an IgG antinucleocapsid antibody response. Follow-up data were available at 6 months postdiagnosis for 60 of 74 patients (81%) with positive initial antinucleocapsid serology, and 15 (25%) of them had negative antinucleocapsid serology at month 6. In total, 14 of 15 sera were tested for antispike antibodies, 3 of 14 (21%) of which were also negative. Overall, 97% of antinucleocapsid-antibody-positive specimens were also antispike-antibody positive. Female sex, age >70 years, and nonsevere clinical presentation were independently associated with faster IgG antinucleocapsid titer decay in multivariable analysis. After adjustment for sex and age >70 years, nonsevere clinical presentation was the only factor associated with faster decay of IgG antispike antibodies.

Conclusions: This study characterizes evolution of the SARS-CoV-2 antibody response in patients on hemodialysis and identifies factors that are associated with lack of seroconversion and with IgG titer decay.

Keywords: COVID-19; SARS-CoV-2; SARS-CoV-2 antibody; hemodialysis; serology.

Figure 1.

Evolution of SARS-CoV-2 IgG antinucleocapsid (NC) antibody titer until 6 months after diagnosis. (A) Evolution of SARS-CoV-2 IgG titer for each patient over time (spaghetti plot). Cutoff for negative serology was defined according to the manufacturer (Index sample/control <1.4: dashed line). The zone between the dashed lines (1.4 and 0.5) represents the equivocal zone. The y-axis is plotted in logarithmic scale. (B) Predicted SARS-CoV-2 antibody decay according to age, sex, and disease severity (multivariable model). Cutoff for negative serology: index sample/control <1.4; dashed line. The zone between the dashed lines (1.4 and 0.5) represents the equivocal zone.

Figure 2.

Evolution of SARS-CoV-2 IgG antispike antibody titers until 6 months after diagnosis. Evolution of SARS-CoV-2 IgG titer for each patient over time (spaghetti plot). Cutoff for negative serology was defined according to the manufacturer (Index S/C <1: dashed line).