Hepatitis C in hemodialysis: epidemiology and prevention of hepatitis C virus transmission.

Hemodialysis (HD) patients were recognized as a high risk group for hepatitis C virus (HCV) infection almost immediately after the identification of HCV in 1989. Both transfusional and nosocomial transmission of HCV were then relatively frequent in HD. The dramatic reduction in transfusional transmission of HCV in the 1990s soon underlined the strongly suspected nosocomial risk. Multiple molecular virology reports eventually demonstrated patient to patient transmission. The reinforcement of hygienic precautions and/ or isolation strategies was the main subsequent step taken by most HD units. Both incidence and prevalence of HCV then decreased substantially in most western HD units. Currently, incidence is much lower whereas prevalence is largely influenced by the rate of acquisition of HCV prior to starting HD (be it in the remote past). Still, the risk of occasional nosocomial transmission remains. The actual application of basic hygienic precautions remains the cornerstone of the prevention of HCV nosocomial transmission, as reviewed in the recently published KDIGO guidelines on HCV in CKD.