Hepatitis C virus infection is still common among dialysis patients, but the natural history of HCV in this group is not completely understood. Recent evidence has been accumulated showing that anti-HCV positive serologic status is significantly associated with lower survival in dialysis population; an increased risk of liver and cardiovascular disease-related mortality compared with anti-HCV negative subjects has been found. According to a novel meta-analysis (fourteen studies including 145,608 unique patients), the adjusted RR for liver disease-related death and cardiovascular mortality was 3.82 (95% CI, 1.92; 7.61) and 1.26 (95% CI, 1.10; 1.45), respectively. It has been suggested that the decision to treat HCV in patients with chronic kidney disease be based on the potential benefits and risks of therapy, including life expectancy, candidacy for kidney transplant, and co-morbidities. According to recent guidelines, the antiviral treatment of choice in HCV-infected patients on dialysis is mono-therapy but fresh data suggest the use of modern antiviral approaches (i.e., pegylated interferon plus ribavirin). The summary estimate for sustained viral response and drop-out rate was 56% (95% CI, 28–84) and 25% (95% CI, 10–40) in a pooled analysis including 151 dialysis patients on combination antiviral therapy (conventional or pegylated interferon plus ribavirin). 1. Introduction Hepatitis C virus (HCV) infection remains frequent in patient receiving long-term dialysis both in developed and less-developed countries. The natural history of HCV infection in dialysis patients remains incompletely understood; controversy continues even in patients with intact kidney function. Defining the natural history of HCV remains difficult for several reasons: the disease has a very long duration, it is mostly asymptomatic, and determining its onset may be difficult. Additional factors can modify the course including coinfection with HBV, HIV, and alcohol use. Because treatment is widely used, future natural history studies of chronic HCV may not be possible as easily documented onset of infection, that is, posttransfusion HCV, no longer occurs [1, 2]. Assessing the natural history of hepatitis C among patients on regular dialysis is even more problematic because of additional characteristics of this population. Nephrologists have been reluctant to perform liver biopsy due to concern about abnormalities in platelet function in uraemia. Amino-transferase activity is lower in patients with chronic renal failure than in nonuremic population, and this may hamper recognition
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