DOI: https://doi.org/10.36347/sjams.2025.v13i10.015

Pages: 1776-1785

Background: Malnutrition and protein-energy wasting (PEW) remain highly prevalent in patients receiving maintenance hemodialysis (HD) and are strong predictors of morbidity, hospitalization, and mortality. Nutritional care is a fundamental yet often underemphasized component of dialysis management. Understanding the metabolic alterations, dietary requirements, and evidence-based interventions is therefore essential for nephrology residents and trainees. Summary: This overview synthesizes current recommendations and practical principles for nutritional management in hemodialysis patients, drawing upon recent KDOQI, ESPEN, and KDIGO guidelines. It discusses the multifactorial pathophysiology of malnutrition, tools for nutritional assessment, and optimal targets for energy (30–35 kcal/kg/day) and protein intake (≥1.2 g/kg/day). Electrolyte and micronutrient management—including sodium, potassium, phosphorus, and water-soluble vitamins—is detailed, with emphasis on individualized approaches. The review also explores intradialytic and oral nutritional supplementation, the role of education and multidisciplinary teamwork, and the emerging shift from restrictive to personalized nutritional strategies. Key Messages: Effective nutritional care in HD improves survival, quality of life, and functional capacity. Early identification of at-risk patients, regular assessment, and integration of dietetic expertise into the dialysis team are critical. Training nephrology residents to approach nutrition as a core therapeutic component, rather than an adjunct, is essential for optimizing patient outcomes.