Malnutrition, which is common in maintenance hemodialysis (HD) patients, is strongly associated with increased morbidity and mortality. Protein requirements in HD patients are increased twice or more compared to those of healthy subjects. Underdialysis leads to anoraxia with low protein and energy intake in relation to the requirements, resulting in protein and energy malnutrition, generally accepted recommendations for dialysis prescription regarding dose of dialysis and protein intake are probably inadequately low in relation to the requirements.