The surveillance of HCV infections is now a must in the clinical management of hemodialysis patients. The natural history of HCV has shown acute hepatitis to be a constant feature although rarely symptomatic. Progression to chronicity occurs in 90% of the cases with detectable viremia in 80% of the cases. The long-term impact of the liver disease in chronic hemodialyzed patients remains to be defined. HCV is responsible for more than 90% of the non-A, non-B hepatitis case diagnosed among hemodialyzed patients. The transmission is either transfusional or nosocomial. Following recent transfusion safety regulations, the nosocomial risk became the predominant residual risk. Thus, all efforts should target HCV eradication. In the absence of specific prophylaxis, this can only be achieved by enforcement of very stringent precautions.