**2.5 RRF and nutritional status**

Malnutrition is a common serious problem in dialysis patients, may be result of multiple factors including impairments in protein and energy metabolism, hormonal imbalances and poor food intake because of anorexia (Ikizler, Hakim et al, 1996). Dialysis dose may affect nutritional status and low dialysis efficacy is associated with higher rates of morbidity and mortality (Gotch, Sargent, 1985; Bergstrom, Lindholm, 1993). RRF contributes significantly to the appetite and total caloric intake (Wang, Sea et al, 2001; Wang, Sea et al, 2005), and overall nutritional status assessed using subjective global assessment, handgrip strength, or lean body mass in both HD and PD patients. Nutritional status is closely related to inflammation. In our study (Brener, Thijssen et al, 2008) anuric HD patients were older with lower baseline serum albumin and showed a trend toward greater length of stay for all causes, and all cause mortality including infectious mortality. Analysis of albumin kinetics performed in HEMO Study showed that a decrease in serum albumin in adequately dialysed patients was mostly due to an increase in the level of inflammation, rather that a decrease in protein intake (Kaysen, Dubin et al, 2000).
