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Infection with the hepatitis B virus (HBV) has serious public health concerns. HBV infection can lead to acute hepatitis B (AHB) or chronic hepatitis B (CHB). After recovery, the viral genome (DNA) may persist for an extended period within the liver tissue and sometimes in the peripheral mononuclear cells and serum, leading to occult hepatitis B virus infection (OBI), which is characterised by the absence of HBV surface antigen (HBsAg). Additionally, the existence of OBI DNA poses a threat to specific patient groups, such as those with patients undergoing hemodialysis. The available literature has shown ongoing efforts to improve understanding of the immune defence of hemodialysis patients. This review aims to support these efforts and elucidate the immune response's role in patients undergoing hemodialysis with OBI.