Although the present study has evaluated a small number of patients and has the limitation of being cross-sectional, we could speculate that the proposed recommendation of 30 to 35 kcal/kg per d for hemodialysis patients might not be sufficient to attend the energy requirement of patients with severe HPT. The same can be speculated regarding protein recommendation. Thus, until an effective treatment of the HPT is reached, a careful monitoring of the nutritional status of these patients should be used to guarantee the supply of sufficient amounts of energy and nutrients to overcome the possible higher requirements. Furthermore, a prospective study would be necessary to prove the relationship between malnutrition and HPT.