Maintenance hemodialysis patients are at high risk for HCV infection due to low immune function, repeated blood transfusions and various other medical factors. Their prevalence is significantly higher than that of the general population. The incidence of HCV in domestic maintenance hemodialysis patients ranges from 7.2% to 84.1%. HCV infection in dialysis patients not only affects the quality of life, but also is one of the important reasons for increasing complications, mortality and loss of function of transplanted kidney. Therefore, patients with end-stage renal disease combined with hepatitis C should be treated aggressively to improve the quality of life and prognosis of patients. The therapeutic goal of antiviral therapy: to prevent HCV infection-related liver disease and its complications including hepatocellular inflammation, fibrosis, cirrhosis, hepatocellular carcinoma and even death in HCV-infected patients; its therapeutic endpoint is to clear HCV infection and obtain a sustained virological response (SVR). Indications for antiviral therapy in general hepatitis C patients: all patients with a primary diagnosis of compensated chronic hepatitis C who are willing to receive treatment without contraindications to interferon or ribavirin, regardless of their serum ALT levels, should receive standardized anti? viral therapy. Those with progressive liver fibrosis (METAVIR score of F3 to F4) and suspected moderate cirrhosis at the time of initial diagnosis should be treated as soon as possible; in patients with mild liver disease with hepatitis C, especially those with long-term infection, the benefits and risks of treatment should be fully considered, and the expected efficacy of new antiviral drugs should also be predicted, as well as the patient’s life expectancy; patients with genotype 2/3 should receive antiviral therapy whenever possible. Indications for antiviral therapy in hemodialysis patients: All untreated hemodialysis patients with HCV infection and compensated liver function should be considered for antiviral therapy, but the pros and cons, including life expectancy, renal transplant candidacy, and complications, should be weighed more heavily before deciding on antiviral therapy. Absolute contraindications to antiviral therapy: uncontrolled depression, psychosis, epilepsy, uncontrolled autoimmune disease, decompensated cirrhosis (Child Pugh score B7 or higher), pregnant women or couples not on contraception, other serious co-morbidities such as uncontrolled hypertension, heart disease, diabetes mellitus and chronic obstructive pulmonary disease, and patients with intolerable granulocyte, platelet and hematocrit levels. Relative contraindications: (omitted). Pre-treatment baseline monitoring indicators: Patients should be systematically evaluated before antiviral therapy, including comprehensive history taking, HCV RNA load and genotype, liver and kidney function, blood glucose, blood and urine routine, thyroid function and autoantibodies. If indicated, cardiac and pulmonary evaluation, psychiatric evaluation, and host genetic testing should be performed. Current standard antiviral regimen (SOC) for general primary chronic hepatitis C patients: (1) pegylated interferon (PEG-IFN) α in combination with ribavirin; (2) both types of IFN, PEG-IFNα-2a (180 μg, 1 time/week) and PEG-IFNα-2b (1.5 μg/kg, 1 time/week), in combination with ribavirin (RBV) for (3) The recommended dose of RBV is 15 mg/kg for patients with genotypes 1 and 4-6, and 800 mg/day is recommended for genotypes 2 and 3; (4) The dose of RBV is calculated according to 15 mg/kg for genotypes 2 and 3 combined with high viral load, severe fibrosis/cirrhosis, obesity, insulin resistance, and other low-response factors. Advances and options for antiviral treatment regimens for hepatitis C combined with dialysis patients: 2008 KDOQI guideline opinion: For hepatitis C patients on maintenance dialysis, plain interferon is recommended and RBV (weak) is not recommended; if combined RBV therapy is considered, great caution and necessary precautions must be taken. 2009 AASLD guideline opinion: Patients with HCV on maintenance hemodialysis may be considered for treatment with plain interferon 2a or 2b (3 mU, 3 times per week), or reduced dose PEG-IFN alpha-2a at 135 μg per week or alpha-2b at 1 μg/kg per week) (Class IIa, Level C). Reduced dose RBV therapy may be combined with close monitoring for side effects such as anemia (Class IIb, Level C). 2011 EASL guideline opinion: In dialysis patients, the application of PEG-IFNα monotherapy is safe, but the combination of individualized doses of RBV therapy is subject to patient screening and individualized protocols. The 2012 APASL guideline opinion: both standard interferon α and low-dose PEG-IFNα-2a (135 μg/week) or α-2b [1 μg/(kg?week)] are recommended for dialysis patients with HCV infection (II-1). RBV should be significantly reduced in daily dose if combined with interferon therapy (II-3). Interferon alpha is contraindicated in renal transplant recipients unless the benefits of treatment outweigh the risks (II-2). The latest antiviral dose approved by the FDA in 2011 for patients on dialysis with hepatitis C: Pyroxin (PEG-IFNα-2a) 135 μg/week and RBV 200 mg/day, with close monitoring during RBV dosing and prompt discontinuation in case of adverse reactions or abnormal indicators. Definition of virological response indicators during antiviral therapy: Rapid virological response (RVR): HCV RNA level below the lower limit of detection at 4 weeks of treatment; Early virological response (EVR): HCV RNA positive at 4 weeks of treatment, below the lower limit of detection at 12 weeks; Delayed virological response (DVR): HCV RNA not negative at 12 weeks of treatment, but reduced by more than 2 Log (DVR): HCV RNA was not negative at 12 weeks of treatment, but decreased by more than 2 Logs and was negative at 24 weeks of treatment; End of Treatment Response (ETR): HCV RNA was negative at the end of treatment; Sustained Virological Response (SVR): HCV RNA remained negative from the end of treatment to 24 weeks of follow-up. Antiviral treatment regimen: mainly refer to the standard antiviral treatment regimen for general hepatitis C patients, adjusted according to genotype and virological response. (1) 24 weeks for genotype 2/3 and 48 weeks for genotype 1/4. (2) Regardless of genotype, treatment should be discontinued if viral decline levels are below 21og at 12 weeks of therapy or if HCV RNA is still detectable at 24 weeks of therapy; (3) For DVR at 24 weeks of therapy, the regimen should be extended to 72 weeks for genotype 1/4 and 48 weeks for genotype 2/3; (4) For low baseline virologic levels (<400