BACKGROUND: The clinical course of hemodialysis patients with COVID-19 still remains unclear.
METHODS: Thirty-four hemodialysis patients were retrospectively enrolled. Patients were divided according to disease severity, and clinical symptoms and laboratory data at admission were compared.
RESULTS: The serum C-reactive protein (CRP) level, D-dimer level, and white blood cell (WBC) count were significantly higher in the group with critical disease than in the group with mild to severe disease (P = 0.005, P = 0.039 and P = 0.045). The serum CRP level exceeded 10 mg/dL within 7 days of clinical onset in all the cases with critical disease.
CONCLUSIONS: Hemodialysis patients with COVID-19 who have elevated serum CRP and D-dimer levels, and an elevated WBC count at admission and patients with serum CRP levels exceeding 10 mg/dL before day 7 after clinical onset should be carefully monitored for possible progression to critical disease. This article is protected by copyright. All rights reserved.

IFNL4 polymorphisms are associated with circulating IFN-λ3, and higher plasma IFN-λ3 are associated with higher production of antibodies to HBV surface antigen (anti-HBs). The IFNL4 rs8099917 T allele and anti-HBs development in response to HBV vaccine are associated with better survival in hemodialysis (HD) patients.
To show whether plasma IFN-λ3 is also a predictor of survival in HD patients.
Plasma IFN-λ3 was measured in 135 HD patients who were followed-up for 2.6 years. Survival probability was tested using the Kaplan-Meier method and the Cox proportional hazard model.
Plasma IFN-λ3 (ng/L) was 116.8 (20.4-227.5) in survivors on HD (n=89, 65.9%), 75.1 (36.0-228.8) in deceased patients (n=37, 27.4%), and 109.0 (40.0-232.7) in subjects submitted to kidney transplantation (n=9, 6.7%). IFN-λ3 was lower in deceased patients than that in all remaining patients (P=0.039) and patients who continued HD without transplantation (P=0.028). IFN-λ3 and anti-HBs titers were correlated (r=0.587, P<0.000001). Patients showing IFN-λ3 >126.1 ng/L (3rd tertile) presented better survival compared with patients with IFN-λ3 in the 1st (<73.8 ng/L, P=0.005) and 2nd (≥73.8 - <126.1 ng/L, P=0.013) tertiles. Each decrease in IFN-λ3 per 10 ng/L was associated with a hazard ratio equal to 1.076 (95%CI 1.015-1.140, P=0.013). In multivariate analysis, the independent predictors of survival were age (P=0.008), dialysis modality (P=0.038), circulating IFN-λ3 (P=0.044), and diabetic nephropathy (P=0.047), but not gender, dialysis duration prior to the study, mean arterial pressure, BMI, CRP, albumin, 25(OH)D, or anti-HBs.
Circulating IFN-λ3 is a promising predictor of HD patient survival.

Interferon lambda-3 (IFNλ3) which is also known as IL28B is a member of type III Interferons which are structurally and genetically different from type I Interferons. These Interferons induce signal transduction pathways similar to type I Interferons which results in the activation of Interferon Stimulated Genes (ISGs). This group of Interferons are tissue specific and reported to have antiviral activity. In the present communication, we report the expression of bovine IFNλ3 gene (coding for the mature protein) in Pichia pastoris, purification of the expressed protein and evaluation of its biological activity. About 19 kDa protein expressed by the transformed Pichia cells, secreted into the media and the protein was purified by SP-Sepharose ion exchange chromatography with NaCl stepwise gradient elution. Specificity of the protein was confirmed by Western blotting. Pichia expressed IFNλ3 was found to be biologically active, as it induced ISGs (Mx protein, OAS and PKR genes) in bovine PBMCs. Further it was also found to modulate Th1/Th2 cytokines expression in the stimulated bovine PBMCs.

BACKGROUND: Circulating pro-inflammatory cytokines were associated with increased relative mortality risk, while immune parameters reflecting improved T-cell function were predictors of survival in hemodialysis (HD) patients. We evaluated in the prospective study whether variants in T helper cell cytokine-associated genes are determinants of mortality in HD patients.
METHODS: The study was carried out in 532 prevalent HD subjects who were followed-up for 7 years. HRM analysis was used for IFNL3, IL12A, IL13, and IL4R genotyping. CCL2, IL12B, and IL18 were genotyped using PCR-RFLP analysis. Survival analyses were conducted using the Kaplan-Meier method and the Cox proportional hazard model.
RESULTS: In univariate analyses, IFNL3 rs8099917 was associated with all-cause mortality in recessive model of inheritance (log-rank test P = 0.044), IL12A rs568408 - in dominant model (log-rank test P = 0.029). Minor homozygotes (the genotype GG) in IFNL3 rs8099917 showed shorter survival during the study (3.6, 1.0-7.0 years vs 4.7, 0.1-7.0 years, P = 0.009) than the major allele (T) bearers. The rs8099917 GG patients demonstrated higher risk of death than the remaining patients (GT + TT) (OR 1.94, 95%CI 1.11-3.40, P = 0.020). Major homozygosity (the genotype GG) in IL12A rs568408 was associated with higher mortality than that shown in bearers of the minor allele (AA + AG) (HR 1.31, 95%CI 1.02-1.69, P = 0.035). In multivariate analyses, however, the mentioned polymorphisms were not independent predictors of survival.
CONCLUSIONS: Polymorphisms of IFNL3 rs8099917 and IL12A rs568408 contribute to survival of HD patients, but not as independent factors.