Mortality and morbidity on dialysis remains high regardless of age in spite of technological improvements. While some of this is explainable and acceptable and related to co-morbid problems such as heart disease, malignancy, diabetes, etc. much is also preventable. Data from the literature would indicate that the provision of adequate dialysis as determined by a Kt/V (urea) of > 1.2 or a urea reduction rate (URR) > 65% will improve outcome. Attention to the nutritional status of the patient should also have impact. Low serum levels of urea, creatinine, albumin, anion gap, ideal body weight, and a low dietary protein intake as suggested by a reduced protein catabolic rate, are bad prognostic features. The elderly are more likely to have these features. While many factors may contribute to or cause protein malnutrition, underdialysis should be one easily recognized and reversible cause. Underdialysis will inevitably lead to poor nutrition and have an adverse effect on outcome.