Forty seven patients with end-stage renal disease (ESRD) on maintenance hemodialysis at the Najran General Hospital, Najran, Saudi Arabia were studied for prevalence of hepatitis C virus (HCV) infection. A total of 24 patients (51.1%) were found to be positive for anti-HCV antibodies. Duration of hemodialysis was longer (p = < 0.025) in anti-HCV positive patients (4.9 +/- 2.9 years) as compared to anti-HCV negative subjects (1.7 + 1.4 years). No significant relationship was found between blood transfusions and anti-HCV positivity. Ten (41.7%) of the anti-HCV positive patients showed elevated liver enzymes in comparison with two (8.7%) of the seronegative patients. This difference was statistically significant (p = < 0.05). Liver biopsies from eight of the anti-HCV positive patients demonstrated cirrhosis in one, chronic active hepatitis in three, chronic persistent hepatitis in three and normal histology in one patient. There was no correlation between liver enzymes and the severity of histopathological findings on liver biopsy.