There is a high prevalence of nutritional disorders in maintenance hemodialysis patients. This fact has been recently confirmed because larger routine assessments of MHD patients body composition are now performed. Food records and dietary interviews show spontaneous low intakes of protein and energy in many patients. An increasing dialysis dose above a Kt/V (single pool) of 1.5 may not improve patients nutritional intakes. Inflammation may further impair the balance between protein synthesis and catabolism and cause anorexia. In response to these abnormalities, the management of energy, protein, vitamins, and trace elements intake will be discussed with special emphasis on calcium, phosphorus, enteral support, and parenteral nutrition.