Malnutrition has been recognized in maintenance hemodialysis patients since the initiation of this long-term therapy. The cause of protein-caloric malnutrition in the chronic dialysis population is multifactoral, with decreased intake, increased loss, and altered metabolism as likely major categories. Despite marked improvement in the techniques and adequacy of hemodialysis and peritoneal dialysis, protein and caloric therapy has not changed in dialysis patients. Assessment of malnutrition has not been pursued as vigorously as necessary. Moreover, failure to document the diagnosis has distorted interpretation of the reported increasing mortality in this population. More intensive assessment and documentation of malnutrition states, along with alteration in the therapeutic approach, is warranted if we hope to positively affect the mortality of maintenance dialysis patients.