#1173 The duration of SARS-CoV-2 persistence in dialysis patients was inversely correlated with serum albumin levels
Authors: Kuroki Aki , Shimura Satoru 
Published: May 2024

Abstract

Background and Aims
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who are undergoing dialysis are known to experience delayed viral clearance. However, the clinical characteristics that contribute to viral persistence in these patients have not been well documented.
This study reviewed a case series of dialysis patients infected with SARS-CoV-2 at Yokohama General Hospital to investigate factors affecting the duration of viral persistence. The association between clinical features and the duration of SARS-CoV-2 persistence, as assessed by serial viral antigen (Ag) titers, was examined.

Method
This was a retrospective observational study of 22 dialysis patients infected with SARS-CoV-2 between February 2022 and September 2023 at Yokohama General Hospital. Patients who tested positive for SARS-CoV-2 RNA in nasopharyngeal swabs or saliva were diagnosed with coronavirus disease 2019 (COVID-19). Those with confirmed COVID-19 were serially tested for SARS-CoV-2 Ag on nasopharyngeal swabs. The duration of viral persistence was defined as the interval between the day of diagnosis and the first day that Ag titers fell below 10 pg/mL. Clinical parameters were collected and their association with the duration of Ag positivity was examined. Parameters analyzed included age, body mass index (BMI), dialysis vintage, serum albumin and C-reactive protein (CRP), COVID-19 severity at diagnosis, fever duration, and comorbidities including cardiovascular disease, diabetes, hypertension, and dyslipidemia. COVID-19 severity was classified as mild, moderate I, moderate II, or severe, following the Japanese Ministry of Health, Labour and Welfare guideline. The groups were compared using the Kruskal-Wallis test. Spearman's rank correlation coefficient was used to analyze the correlation. Statistical analyses were performed using JMP version 17.

Results
Out of the 22 dialysis patients who were infected with SARS-CoV-2, two were excluded from the study due to a lack of serial results for SARS-CoV-2 Ag. Five of the patients were outpatients, while the remaining were infected in hospital clusters. The patients had a mean age of 76.6 years (SD=7.1), and 17 of them were male. Ten of the patients had diabetes mellitus, 11 had hypertension, and 10 had dyslipidemia. Cardiovascular disease was excluded from the analysis because all patients, except for two, had it. The median BMI was 19.45. The median dialysis vintage was 57.5 months. Serum albumin levels ranged from 1.4 g/dl to 4.0 g/dl, with a median of 3.1 g/dl, and CRP levels ranged from 0.38 mg/dl to 8.70 mg/dl, with a median of 2.57 mg/dl. At the time of diagnosis, 15 and 5 patients were classified as having mild and moderate I disease, respectively. Seventeen patients had fever, which lasted from 1 to 11 days, with a median of 3 days.
The duration of antigen positivity ranged from 10 to 26 days with a median of 18 days. The duration of Ag positivity showed an inverse correlation with serum albumin levels, which was the only parameter associated with viral clearance (Table 1 and Fig. 1).

Conclusion
Serum albumin levels were associated with prolonged viral clearance in a small series of dialysis patients infected with SARS-CoV-2 in our study. Serum albumin levels may have prognostic value for the viral clearance in dialysis patients.