Body weight was measured with light clothing on up to 0.1 kg. Height was measured up to 0.1 cm. Waist circumference was measured at the midpoint between upper iliac and lower costal level up to 0.1 cm at the end of normal expiration. Hip circumference was measured around the largest part of the hip. Anthropometric measurements were obtained immediately after the HD session by a trained researcher. Body mass index (BMI) was calculated as body mass divided by stature squared. The International Society of Renal Nutrition and Metabolism(ISRNM) panel recommends that a BMI lower than 23 kg/m2 is a marker of Protein Energy Wasting(PEW). Anthropometric measurements include TSF used skinfold calipers; MAC measured by a stretchable measuring tape, MAMC equals MAC(centimeter) - 3.14 x TSF (millimeter)/10 and MAMA equals (MAMC2/4π). Muscle mass area (MMA) was calculated using the following equation: MMA = ([MAC {cm} - π x triceps skinfold {cm}]2/4π) -n, where n = 10 for men and 6.5 for women . Muscle strength as hand grip strength (HGS) test was measured by Hand Dynamometer. HGS was measured 3 times for both left and right hands with patients in a standing position using a dynamometer in units of kilograms. Patients held the dynamometer at thigh level and were encouraged to squeeze the instrument as hard as possible for 3 s. The maximum grip strength among all measurements was used for this study. Three sets of measurements at each site were averaged and used in the analyses.