Patients receiving maintenance hemodialysis (MHD) are highly vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current study was designed to evaluate the prevalence of SARS-CoV-2 infection based on both nucleic acid testing (NAT) and antibody testing in Chinese patients receiving MHD.Cross-sectional study.From Dec 1, 2019 to Mar 31, 2020, 1027 MHD patients in five large hemodialysis centers in Wuhan, China were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial chest computed tomography (CT). If patients developed symptoms after initial screening was negative, a repeat CT was obtained. Patients suspected of being infected with SARS-CoV-2 were tested with two consecutive throat swabs for viral RNA. In mid-March 2020 antibody testing for SARS-CoV-2 was obtained for all MHD patients.NAT and antibody test results for SARS-CoV-2.Morbidity, clinical features, laboratory and radiologic findings.Differences between groups were examined by Student's t-test or Mann-Whitney U test, comparing those not infected to those infected and comparing those with infection detected by NAT to those with infection detected by positive serology test results.Among 1027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among these 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive IgG or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on chest CT compared to 11.6% among uninfected patients (P<0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and they were more likely to be symptomatic than patients with another primary cause of kidney failure.Possible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations.Half of the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal chest CT and selective NAT. Serologic testing may help to evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.