Hepatitis C virus (HCV) is a major public health problem and is the most common liver disease among hemodialysis (HD) patients. The seroprevalence of HCV infection among HD ranged from 1.9% to 80% in reports published since 1999. The main risk factor for HCV acquisition in HD patients seems the length of time on HD. Phylogenetic analysis of HCV viral isolates has suggested nosocomial patient-to-patient transmission of HCV infection among HD patients. Lack of strict adherence to universal precautions by staff and sharing of articles such as multidose drugs might be the main mode of nosocomial HCV spread among HD patients. Currently, there are several dilemmas on the management of these patients: should HCV-RNA testing be included in the routine screening of HD population for HCV infection?; does periodic serum alanine aminotransferase testing have a role in screening HD patients for HCV infection?; can dialysis really 'save' the liver of HCV-infected HD patients?; should HCV-infected subjects be isolated and dialyzed by segregated machines?; is there any difference in treating HD and non-HD HCV-infected subjects? This article gathers the present evidence to address these issues and to demonstrate the current worldwide magnitude of HCV in HD population.
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