The aim of this retrospective study was to focus the efficacy of pegylated interferon (PEG-IFN) alpha 2a in chronic hemodialysis patients with hepatitis C and to compare the therapy responses with other chronic hepatitis C patients. Of the anti-HCV positive patients who were admitted to the Infectious Diseases and Clinical Microbiology policlinic from January 2004 to December 2006, 99 were candidates for interferon therapy. Of those, 12 patients were on HD. We began 47 patients on PEG-IFN alpha 2a (180 lg/week) subcutaneously plus ribavirin (1,000-1,200 mg/day) (Group 1), and 12 patients on HD, PEG-IFN alpha 2a, without ribavirin at a dose of 135 lg weekly for 48 weeks (Group 2). In this study of PEG IFN alpha 2a with or without ribavirin, the predictability of a sustained viral response (SVR) was based on the early virologic response (EVR) defined at week 12 as an at least 2-log decline from baseline of the HCV RNA level. About 77% (39/47) of patients achieved an EVR in Group 1 and 58% (7/12) in Group 2 (p = 0.004). A total of 34 (72.34%) patients in Group 1 and 6 patients (50%) in Group 2 had negative HCV RNA at the end of the treatment (p = 0.213). We evaluated SVR after 6 months finishing the therapy; 29 (61.7%) patients in Group 1 and 6 patients (50%) in Group 2 had negative HCV RNA (p = 0.109). PEG-IFN alpha 2a (135 lg weekly) for 48 weeks is efficacious and well tolerated in HD patients with HCV, as well as other chronic HCV patients. However, due to more side effects of IFN specially on platelet counts as compared non-renal HCV patients a closer follow-up, in HD patients is suggested.