Background: The decision to start dialysis for an ESKD patient varies across countries and is influenced by the local nephrology practice, healthcare policies, and cost for dialysis treatment. The Dialysis Outcomes and Practice Patterns Study (DOPPS) Phase 2 with 12 participating countries indicated a greater mortality rate in patients new to dialysis compared to prevalent dialysis patients. Early mortality at the time of dialysis initiation prevails with increased risk up to 80% within the first two months of HD initiation. Apart from catheter vascular access and pre-dialysis care, nutritional status is considered a potentially modifiable risk factor in early mortality. Clearly, pre-existing malnutrition originates from progressive CKD stages 3 to 5 with vulnerability of the patient starting from the point of metabolic derangements associated with falling glomerular filtration rate, late nephrology access, and insufficient pre-dialysis dietetic care during this period. Dialysis treatment is expected to improve nutritional status for patients with a more liberal protein prescription compared to the pre-dialysis stage. However, dialysis treatment is cited to contribute to malnutrition burden, and newly dialyzing patients are at risk of the early mortality attributed to malnutrition as evidenced by diagnostic assessment of nutrition risk screening using SGA, low body mass index (BMI), low mid-arm muscle circumference (MAMC), low albumin, low cholesterol levels, and reduced food intake.