Protein-energy malnutrition (PEM), also referred to as protein-energy wasting (PEW), is a prevalent and debilitating condition among patients undergoing programmed hemodialysis (HD), affecting up to 40-60% of this population. This condition arises from a complex interplay of factors including inadequate nutrient intake, metabolic alterations, inflammation, and dialysis-related losses, leading to increased morbidity, hospitalization rates, and mortality. Effective correction of PEM requires a multifaceted approach encompassing nutritional assessment, dietary interventions, oral nutritional supplements (ONS), intradialytic parenteral nutrition (IDPN), and adjunctive therapies such as exercise and management of comorbidities. This review synthesizes evidence from high-impact studies indexed in databases like PubMed and PMC, highlighting the importance of tailored nutritional strategies to improve clinical outcomes. Key interventions include increasing dietary protein intake to 1.0-1.2 g/kg/day and energy to 30-35 kcal/kg/day for metabolically stable patients, supplemented by ONS or IDPN when oral intake is insufficient. Outcomes from randomized controlled trials demonstrate improvements in serum albumin levels, body composition, and quality of life, with reduced hospitalization risks. However, challenges such as fluid overload, hyperphosphatemia, and patient compliance necessitate individualized plans. Future research should focus on long-term efficacy and integration of novel biomarkers for early detection and intervention.

protein-energy malnutrition; Protein-energy wasting; Hemodialysis; Nutritional intervention; Dietary protein intake; Oral nutritional supplements; Intradialytic parenteral nutrition; Chronic kidney disease; Inflammation; Metabolic acidosis

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