Malnutrition and protein wasting are common features of chronically uremic patients, whether on conservative or dialysis treatment. Optimization of protein-energy intake is difficult because of anorexia, catabolic factors (acidosis, insulin resistance, cytokines, etc.) and intercurrent infections. The use of growth hormone may improve the efficiency of dietary protein utilization. Evidence suggests a small but appreciable effect of very low protein diets on progression of renal insufficiency.