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Kidney Week

Abstract: TH-PO1132

SARS-CoV-2 Testing During Routine Hemodialysis Care: A Nationwide Pragmatic Clinical Trial

Session Information

  • Late-Breaking Posters
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Montez-Rath, Maria E., Stanford University, Stanford, California, United States
  • Varkila, Meri, Stanford University, Stanford, California, United States
  • Yu, Xue, Stanford University, Stanford, California, United States
  • Parsonnet, Julie, Stanford University, Stanford, California, United States
  • Chertow, Glenn, Stanford University, Stanford, California, United States
  • Block, Geoffrey A., Stanford University, Stanford, California, United States
  • Anand, Shuchi, Stanford University, Stanford, California, United States
Background

Patients receiving dialysis face relatively high risks from viral infections including SARS-CoV-2. Early detection could facilitate treatment, reduce transmission, and strengthen public health surveillance. We evaluated the acceptability of routine SARS-CoV-2 screening among asymptomatic patients in dialysis facilities.

Methods

We conducted a pragmatic, cluster randomized trial in 57 US hemodialysis facilities from Feb-July 2023 in partnership with US Renal Care and Ascend Clinical Laboratory (NCT05225298). We tested patient level acceptability of two strategies for offering SARS-CoV-2 rtPCR tests: static frequency every two weeks (arm 1) versus dynamic frequency based on county COVID-19 levels (arm 2). We used wastewater surveillance if available or else CDC case and hospitalization rates to determine frequency of testing in the dynamic arm: weekly, biweekly or every four weeks for high, medium or low community levels, respectively). We randomized facilities by county and offered testing for three months.

Results

2389 patients participated and 12,553 tests were offered (Table). A median of 6 versus 4 tests were offered per patient at static versus dynamic facilities. Test acceptability and positivity rates were 8.0% vs 7.7% (p=0.45), and 2.0% vs. 1.9% (p=0.56), at static versus dynamic facilities.

Conclusion

In this national trial integrating routine SARS-CoV-2 test offer in dialysis care in which a diverse group of patients participated, we found test acceptability was poor and did not vary by testing strategy. A dynamic testing strategy anchored to community transmission resulted in fewer tests offers per patient. Positivity rates among those tested indicate continued risk for transmission even during low COVID-19 incidence.

Funding

  • Other NIH Support – Abbott Clinical Laboratories provided test kits; Ascend Clinical Labs processed test