Hepatitis C virus infection remains a significant cause of illness and death among patients on hemodialysis, and in Egypt it is one of the most common blood-borne infections. A new study from a pediatric dialysis unit in Assiut, Egypt, has now quantified how often children on long-term hemodialysis develop new hepatitis C infection, and the results reveal both a persistent hazard and a striking recent improvement. Over a seven-year observation window, 28 of 70 children—40 percent—converted from antibody-negative to antibody-positive status, yet the annual rate of new infections fell steadily and reached zero in the final two years of the study.

The research, published in the Egyptian Pediatric Association Gazette, was led by Mahmoud Mohamed Zeawela, Ghada Omar Elsedfy, Asmaa Mohamed Abd El Aziz and Asmaa Ahmed Mahmoud. The team set out to detect the prevalence of hepatitis C infection and seroconversion among all hemodialysis patients treated at the Children’s Dialysis Unit at Assiut University Children’s Hospital. Their motivation reflects a broader gap in knowledge: very little is known about hepatitis C infection in infants and children with chronic kidney disease, and the Kidney Disease Improving Global Outcomes initiative has recommended that pediatric nephrologists carefully evaluate how far adult-oriented guidelines can be extrapolated to this young population.

The investigators designed an ambispective observational study, combining a retrospective review of medical records with prospective follow-up. The retrospective phase covered January 2018 through September 2023, while the prospective phase extended from October 2023 to October 2025. All pediatric patients aged between 1 and 18 years with chronic kidney disease who underwent regular hemodialysis for more than one month at the hospital during the study period were eligible, and 70 patients were enrolled. Patients were categorized by anti-HCV antibody status into three groups: those positive before dialysis began, those persistently negative throughout follow-up, and those who seroconverted during the observation period.

Data collection drew on both medical records and structured follow-up forms. Baseline was defined as the time of initiation of regular hemodialysis, and baseline information included demographic characteristics such as age, sex and residence; clinical characteristics including kidney disease etiology, dialysis duration and frequency; and hepatitis C risk factors such as vascular access type, history of blood transfusion, dialyzer reuse and dialysis received outside the study unit. Laboratory assessment relied on enzyme-linked immunosorbent assays to detect anti-HCV antibodies, with HCV RNA confirmed using quantitative polymerase chain reaction. Routine investigations included complete blood count, liver and kidney function tests, and serum electrolytes. Prospective patients were seen every three months under unit infection control protocols to detect seroconversion, monitor viral load and assess treatment response.

The enrolled cohort had a mean age of 12.77 plus or minus 1.83 years. Boys made up 57.14 percent of participants, with girls accounting for 42.86 percent, and most children—65.71 percent—came from urban areas while 34.29 percent came from rural regions. Congenital anomalies of the kidney and urinary tract were the most common cause of chronic kidney disease, followed by glomerulonephritis. Every patient received three hemodialysis sessions per week, with a mean session duration of 3.49 plus or minus 0.34 hours. The median duration of hemodialysis across the cohort was 5.80 years. At baseline, 94.29 percent of patients were anti-HCV negative, meaning only 5.71 percent began dialysis with pre-existing hepatitis C infection.

During follow-up, 28 patients experienced hepatitis C seroconversion. Of these, 26 cases occurred during the retrospective phase, whereas only two were detected during prospective follow-up. The median time from dialysis initiation to seroconversion was 9.51 years, underscoring the cumulative risk that builds with prolonged exposure to hemodialysis. Kaplan–Meier survival analysis showed that most patients remained free of hepatitis C during the first ten years of dialysis, followed by a progressive decline in HCV-free survival as dialysis duration increased, indicating a higher cumulative risk of seroconversion over time. The annual incidence of seroconversion, calculated using the number of patients at risk at the beginning of each year, declined from 10.6 percent in 2018 to 5.0 percent in 2023, with no new seroconversion events recorded in 2024 or 2025.

To identify which factors drove new infections, the team performed univariable and multivariable Cox proportional hazards regression analyses. Duration of hemodialysis emerged as the only independent predictor of seroconversion, showing a significant association in both the univariable model, with a hazard ratio of 0.721 and a 95 percent confidence interval of 0.588 to 0.882 and a p value of 0.002, and the multivariable model, with an adjusted hazard ratio of 0.479, a 95 percent confidence interval of 0.294 to 0.779 and a p value of 0.003.

The risk factor profile of the cohort offered context for these null findings. More than half of the participants—52.9 percent—had a history of blood transfusion, with a mean of 2.51 plus or minus 2.95 transfused units, yet transfusion was not significantly associated with seroconversion in either regression analysis. The authors suggest this may reflect the effectiveness of current blood donor screening programs and improvements in transfusion safety, which have substantially reduced the risk of transfusion-transmitted hepatitis C. They also acknowledge that the relatively limited sample size may have reduced the statistical power to detect such an association, noting that a large global meta-analysis involving more than 1.3 million patients reported approximately twofold higher odds of hepatitis C infection among transfused hemodialysis patients. Hypertension was the most common comorbidity, arteriovenous fistula was the most frequently used vascular access, no patients underwent dialyzer reuse, and only a minority—12.9 percent—received hemodialysis outside the study unit.

The decline in new infections coincided with infection control measures that the dialysis unit has implemented since 2016 under the Assiut University Children’s Hospital policy. The protocol includes routine screening for hepatitis C every three months, strict adherence to standard precautions, hand hygiene, appropriate use of personal protective equipment, environmental cleaning and disinfection of dialysis machines and surrounding surfaces after each session, safe medication preparation and injection practices, proper waste disposal, and regular staff training with periodic monitoring of compliance. Hepatitis C-positive patients were managed according to the unit’s infection control policy to minimize nosocomial transmission. The authors note that although the protocol was formally introduced in 2016, its full protective impact became more apparent after a stabilization period of roughly three to four years, as reflected by the progressive decline and eventual disappearance of seroconversion cases in later years. This pattern is consistent with published data showing that isolation and better infection control cut annual seroconversion from 14 to 15 percent to about 4 to 5 percent per year in adult mixed hemodialysis units in Egypt.

Treatment outcomes among the children who acquired hepatitis C were also reported. All 32 hepatitis C-positive patients received antiviral treatment, and the response rates were encouraging: 56.25 percent achieved improvement, 31.25 percent showed partial improvement defined as a decrease in viral load by polymerase chain reaction, and only 12.5 percent demonstrated no response. These outcomes are comparable to or slightly better than historical cure rates reported with older interferon-based regimens, likely reflecting the use of direct-acting antiviral therapy with sofosbuvir and daclatasvir under the national Egyptian 100 million Health initiative. At the last follow-up, most patients were alive, whereas a minority had died or been transferred to other dialysis centers. The study’s authors conclude that hepatitis C infection remains a significant burden among pediatric hemodialysis patients, with a cumulative seroconversion rate of 40 percent over seven years despite a low pre-dialysis prevalence, but that the marked decline in new cases demonstrates what sustained infection control can achieve in this vulnerable population.

Subject of Research: Hepatitis C seroconversion among children receiving regular hemodialysis for chronic kidney disease

Article Title: Prevalence of seroconversion of hepatitis C virus among children with chronic kidney disease on regular hemodialysis

Article References: Zeawela, M. M., Elsedfy, G. O., Abd El Aziz, A. M., & Mahmoud, A. A. (2026). Prevalence of seroconversion of hepatitis C virus among children with chronic kidney disease on regular hemodialysis. Egyptian Pediatric Association Gazette, 74(1), Article 134. https://doi.org/10.1186/s43054-026-00635-z

Image Credits: AI Generated

DOI: 10.1186/s43054-026-00635-z

Keywords: hepatitis C virus, seroconversion, pediatric hemodialysis, chronic kidney disease, infection control, nosocomial transmission, Cox regression, Kaplan-Meier analysis, direct-acting antivirals, blood transfusion, Egypt, dialysis duration