What is the clinical evidence from this study?

Study design: Observational. Population: End-stage renal disease requiring maintenance hemodialysis (n=470). Intervention: Maintenance hemodialysis. Primary outcome: Prevalence of HCV infection at the time of hemodialysis initiation and at three months of follow-up.

What does this research mean for the field?

HCV prevalence among patients starting hemodialysis is low and remains stable during short-term follow-up, with prolonged dialysis duration being the primary factor associated with infection. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to investigate HCV infection rates at the start of hemodialysis and during initial follow-up.

May 30, 2026Open Access

Hepatitis C Virus Infection at the Start of Hemodialysis and During Early Follow-up: Evidence from Two Dialysis Centers

Key Result

HCV prevalence at the start of hemodialysis was 1.28% and remained stable over three months, while dialysis duration of more than ten years was strongly associated with HCV positivity (P < 0.001).

Key Points

This study aims to investigate HCV infection rates at the start of hemodialysis and during initial follow-up.
Conducted in two hemodialysis centers in northern Iran (2022-2023)
Census-based approach included all adult hemodialysis patients
HCV status assessed via anti-HCV antibody testing at dialysis initiation and after three months
Among 470 patients, 1.28% were anti-HCV positive at dialysis initiation.
No new cases of HCV were identified after three months, indicating stable prevalence.
Longer dialysis duration (more than ten years) showed significantly higher HCV positivity (P < 0.001).

Study Design

Type

Observational (n=470)

Multicenter

Yes

Structured PICO

Population

470 adult patients receiving maintenance hemodialysis in two facilities in northern Iran

Outcome

HCV status assessed by anti-HCV antibody testing at dialysis initiation and repeated after three months

HCV prevalence at the start of hemodialysis is low and remains stable over short-term follow-up, with longer dialysis duration being the primary risk factor for positivity.

Limitations

Absence of systematic HCV RNA testing, relying only on antibody-based ELISA
Low number of HCV-positive cases constrained statistical power
Short follow-up period of three months restricting capacity to detect delayed seroconversions
Reliance on routine clinical registries precluded systematic evaluation of intravenous drug use (IVDU)

Abstract

BACKGROUND: Hepatitis C virus (HCV) remains a concern in patients undergoing maintenance hemodialysis due to repeated blood exposure and prolonged contact with dialysis environments. Although direct-acting antivirals have reduced HCV burden in many settings, uncertainty persists regarding early infection dynamics at dialysis initiation and during initial follow-up. METHODS: This observational study was conducted in two hemodialysis facilities in northern Iran (2022-2023). All adult patients receiving maintenance hemodialysis were included using a census-based approach. HCV status was assessed by anti-HCV antibody testing at dialysis initiation and repeated after three months as part of routine surveillance. Demographic and clinical variables, including dialysis duration and transfusion history, were extracted from medical records. Analyses focused on prevalence and associations with clinical characteristics. RESULTS: Among 470 patients, six (1.28%) were anti-HCV positive at dialysis initiation. After three months, no new cases were identified; overall prevalence remained unchanged. No significant associations were observed between HCV status and demographic variables, transfusion history, or comorbidities. In contrast, dialysis duration showed a clear association with HCV positivity. Patients with more than ten years of dialysis had markedly higher prevalence than those with shorter durations (P < 0.001). CONCLUSIONS: In this cohort, HCV prevalence at the start of dialysis was low and remained stable during short-term follow-up. Longer dialysis duration was the only factor associated with HCV positivity, supporting its role as a cumulative exposure marker. These findings emphasize the importance of sustained infection-control practices and continued surveillance, even in low-prevalence settings.

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