History and physical examination — The history and physical examination can often provide important clues to the patient who might be malnourished. These include: Symptoms such as nausea, vomiting, anorexia, or weight loss or gain. Large interdialytic weight gain is discouraged because it is thought to reflect excessive fluid and sodium intake. In some cases, however, over time, increased body weight gain may represent improved nutritional status [13]. A careful assessment should be performed to distinguish between these possibilities.